HomeMy WebLinkAboutPermit: Stormwater
City of Carmel
Permit #: ______________
STORMWATER MANAGEMENT PERMIT APPLICATION
Submission of this application constitutes notice that the proje site owner is applying for coverage under the Carmel City Code §6-180
through §6-209 for stormwater discharges associated with construction activity disturbing ¼ acre or more of land. Permitted project site
owners are required to comply with all terms and conditions of t
Project Name:
Project Location:
Quarter: Section: Township: Range:
NW/SW
17N3E
Project Site Owner Name: Title/Position:
S
Company:
Address:
1
City: State: Zip:
337
Phone: Fax: E-mail Address:
73
7371
SWPPP Contact Person: Company Name:
Affiliation to Project Site Owner:
Address (If different from above):
City: State: Zip:
Phone: Fax: E-mail Address:
Estimated Project Duration:
By signing this application, I certify the following:
A.The storm water quality measures included in the Storm Water Pol
§6-180 through §6-209 of the Carmel City Code, the City of Carmel Stormwater Techn
federal, state, and local stormwater requirements;
B.The measures required by the Stormwater Pollution Prevention Pla
C.Stormwater quality measures beyond those specified in the Stormwater Pollution Prevention Plan (SWPPP) will be implemented
during the life of the permit if necessary to comply with the Ca
D.Implementation of stormwater quality measures will be inspected
E.Pursuant to Carmel City Code § 6-205, the City reserves the righ
outlined in the Stormwater Pollution Prevention Plan (SWPPP) or provide maintenance thereto, at my expense, if not perfo
JackDeGagne8/24/2012
Signature of Project OwnerPrinted Name Date
______________________________________________________ ________
Permit Approved: Engineering Department Date
Approval of this application constitutes acceptance of the Storm