2. 
6. Description:
8. Project Address*
10. Tax Map No./Legal Description*
14. Applicant Information:
16. Applicant First Name*
17. Applicant Last Name*
19. Applicant Address*
21. Applicant City*
22. Applicant State*
23. Applicant Zip*
25. Phone #:*
26. Email Address*
28. Property Owner of Record*
30. Owner Address*
32. Owner City*
33. Owner State*
34. Owner Zip*
36. Phone #:*
37. Email Address*
41. Certified Responsible Land Disturber Name*
    This individual will be responsible for signing the approved permit.
42. RLD Phone #:*
44. RLD Number:*
45. RLD Expiration Date*
    RLD Expiration Date
49. Site Information:
51. Total Area of the property:
53. Acres
54. Square Feet*
56. Area to be disturbed (including total landscaping):
58. Acres
59. Square Feet*
61. IS PROJECT PART OF A COMMON PLAN OF DEVELOPMENT PLATTED SINCE 2004?*

    1. YES

    1. NO
63. If YES, a SWPPP is required on site.
    SWPPP document can be downloaded from Applications/Forms Page and posted on site to be accessible by Stormwater Staff.
64. ***Link to Applications/Forms Page***
    Applications/Forms
66. If YES, the Potential Sources of Pollution and Prevention Practices application is required.
    Potential Sources of Pollution and Prevention Practices application can be downloaded from the Applications/Forms Page and attached as a separate file below.
70. ALL APPLICATIONS MUST HAVE A COPY OF THE PLAT SUBMITTED.
    For complete submittal, you will need to attach a copy of the plat depicting locations of E&S Measures. (Silt fence, construction entrance, concrete washout, etc.) See Potential Sources of Pollution and Prevention Practices Application for more information.
71. Plat Upload*
75. Potential Sources of Pollution and Prevention Practices Upload
    Please attach the form here. (Can be downloaded from the Applications Page.)
76. PSPPP Document Upload*
Leave This Blank:


78. 1. Receive an email copy of this form.
79. Email address

    This field is not part of the form submission.

80. Submit Submit and Print

* indicates a required field