Soil Erosion And Sediment Control Inspection Application Form - Mchenry - Lake County Soil And Water Conservation District
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2Soil Erosion and Sediment Control Inspection Application
McHenry - Lake County Soil and Water Conservation District
(815)-338-0099 x3
SWCD Application No.:
FOR SWCD OFFICE USE ONLY
_________________
Stormwater Permit No
. :_________________
Date all Information received
Fee Paid
Check No
: _________________________________
:
.:_____________
In-Stream: yes no
APPLICANT (Owner/Developer)
Erosion Control Consultant/Engineer
Business Name
Address
City/State/Zip
Contact Name
E-Mail Address
Phone
Fax
Current Project Name and Phase number: __________________________ Location (Municipality):________________
Job site contact person: ______________________________ E-Mail Address: ___________________________________
Job site Contact’s Phone number: (_______) -__________-___________ Fax number: (_______) -__________-________
Township, range, & section: ________________________________ Nearest Intersection: __________________________
Proposed land use: ________________________________________ Acreage of disturbance:_______________________
McHenry County Storm Water application number: _______________________________________________________
Construction start date: _______________________ Anticipated construction completion date:_____________________
The applicant agrees to the following conditions:
1. Upon submittal of this application, pay the applicable fee (see the attached fee schedule), in accordance with
total acres of the development site and the duration of the project.
2. If applicable, notify the McHenry - Lake County Soil and Water Conservation District (MLSWCD) of the pre-
construction meeting.
3. Allow MLSWCD representatives the right to conduct on-site investigations throughout all active construction
phases to determine whether all necessary SE/SC practices have been installed and are functioning properly.
4. Comply with the McHenry - Lake County SWCD’s written and verbal recommendations regarding SE/SC
permit requirements.
5. Pay additional costs incurred by the SWCD in response to repeated non-compliance issues.
6. If any changes occur to the plans, schedules, etc., the applicant shall be responsible for notifying the McHenry
- Lake County Soil and Water Conservation District.
Applicant’s Signature
Date
:_____________________________________________
:_________________________
Revised September 16, 2008
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