Soil Erosion And Sedimantation Control Application And Permit - City Of Walker
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1CITY OF WALKER
SOIL EROSION AND SEDIMANTATION
CONTROL APPLICATION AND PERMIT
APPLICATION FEE: $
RECEIPT#
PERMIT FEE: $
PERMIT #:
INSPECTION FEE: $
(
X
)
DATE:
DATE PAID:
BY:
BOND AMOUNT:
CITY ENGINEER
For Office Use Only (above)
SITE ADDRESS: ___________________________________________________________________________
TYPE OF PROJECT (AND NAME): ____________________________________________________________
APPLICANT:
NAME:
ADDRESS:
CITY:
STATE, ZIP:
PHONE:
FAX:_________________
NAME OF PROPERTY OWNER OF RECORD, IF OTHER THAN APPLICANT:
NAME:
ADDRESS:
CITY:
STATE, ZIP:
PHONE:
FAX:_________________
SOIL EROSION AND SEDIMENTATION CONTROL PLAN
NOTE:
TWO (2) SETS OF COMPLETE PLAN MUST BE ATTACHED.
ESTIMATE COST OF TEMPORARY EROSION CONTROL: $________________________________________
PLAN PREPARERS NAME: _______________________________
COMPANY NAME: _______________________________________
SIZE OF PARCEL:_______________________________Disturbed Area:_______________________________
SOIL TYPE:________________________________________________________________________________
TIMING SEQUENCE: ________________________________________________________________________
TEMPORARY CONTROL MEASURES: _________________________________________________________
PERMANENT CONTROL MEASURES: _________________________________________________________
QUANITY OF CUT 0R FILL (CIRCLE ONE): ______________________________________________________
COST OF STABILIZATION: ________________ TEMP: _______________________ PERM: ______________
PERMANENT MAINTENANCE: ________________________________________________________________
I (we) affirm that the above information is accurate and that I (we) will conduct the above described earth
change in accordance with Part 91, Act 451, P.A. of 1994 as amended and Walker Ordinance 94-441 as
amended article, being section 36-206 of the City of Walker Code of Ordinances.
Signature: __________________________________ Title: ___________________ Date: __________________
Print Name: ________________________________
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