|
APPLICATION FOR PERMIT SOIL EROSION AND SEDIMENT CONTROL
In accordance with Part 91 of Act 451, of 1994 and it's corresponding general rules, the undersigned makes application to do the following project: PROJECT TYPE:_________________________________ SIZE OF TOTAL EXC.: __________________ (new residence, septic system, driveway, etc.) (acres or square feet) DISTANCE TO WATER: ____________ft. NAME OF NEAREST WATER: ____________________ (lake, river, stream, drain, etc.)
TOWNSHIP:________________________Sec.#________Property #(Tax I.D.#)_________________________
PROJECT ADDRESS:__________________________ SUBDIVISION:___________________ LOT#______
Project START Date: ____________________, Project COMPLETION date: _____________________
NOTE: This office has thirty (30) days to inspect and approve/deny an application for permit from the date the application is received in our office. No work can be done until the inspection is received.
APPLICANT: ____________________________________ Owner __ Contractor __ Other __ ADDRESS: ____________________________________ CITY,STATE,ZIP: ____________________________________ PHONE: _________________________
LAND OWNER: ____________________________________ ADDRESS: ____________________________________ CITY,STATE,ZIP: ____________________________________ PHONE: _________________________
Responsible party for earth change NAME : ____________________________________________ PHONE: __________________________
Responsible party for final stabilization NAME: ____________________________________________ PHONE: _________________________
NOTE: All disturbed soils need to be stabilized within 5 days of project completion in accordance with Rule 1709, subsection (5) of Part 91 of Act 451, of 1994 as amended.
Permittee agrees to indemnify the County of Clare and all of its departments, agencies, boards, commissions, officers, employees, and agents from any and all liability arising under or in any manner related to the issuance of the Permit or the privileges granted under this Permit.
The property owner, contractor, and any agent in obtaining this Permit are held responsible to insure the project is constructed in accordance with all drawings and specifications contained in this Permit.
The permittee hereby acknowledges and accepts sole liability for any injury to persons or property which may result from the activities authorized by issuance of this permit.
* * I understand that payment of the application fee does not guarantee a permit. * * I hereby submit this application and site plan which is to be followed in detail. I hereby authorize the Soil Erosion Control Agent to inspect this project site. |
|
Clare Conservation District Application for Permit Soil Erosion and Sediment Control Allow 30 Days for Approval |
|
Date Rec. ____________
Rec #: ____________
Permit #: ____________ |
|
__________________________________________ LANDOWNER / DESIGNATED AGENT |
|
________________________________________ Date |