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2. Application Date
   Application Date
3. Permanent Parcel Number
5. Property Address
7. Owner and Applicant Statement
   Statement Under penalty of intentional misrepresentation and/or perjury, I declare that I have examined and/or made this application and it is true and correct to the best of my knowledge and belief. I agree to construct said improvement in compliance with all provisions of the applicable ordinances. I realize that the information that I have affirmed hereon forms a basis for the issuance of the storm water management permit(s) herein applied for and approval of plans in connection therewith shall not be constructed to permit any construction upon said premises or use thereof in violation of any provision of any applicable ordinance or to excuse the owner or his successors in title form complying therewith. All parts of the permit submittal may be made available for inspection and copying pursuant to applicable sections of the Storm water and Floodplain Management Ordinance.
9. Applicant Name
11. Address
13. City
14. State
15. Zip
17. Telephone
18. Email
20. Check if Owner Information Same as Applicant

    1. Yes
    2. No
22. Owner Name
24. Address
26. City
27. State
28. Zip
30. Telephone
31. Email
33. Development Narrative
35. Plans
37. Buffers on Site

    1. No Floodplain or Waterway Buffer Present on the Site
    2. No Wetland or Wetland Buffer Present on the Site
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field