Application For Stormwater Permit

Download Word Document Version

La Porte County Application for an Erosion and Sediment Control Permit

"*" indicates required fields

Project Name*

Project Location Description*

Hydrologic Unit Code*

Receiving Water/Point of Discharge*

Plan Submittal Date*

Civil Township

Quarter

Section

Township

Range

Latitude and Longitude*

Total Project Acreage*

Acreage to be Disturbed*

Number of Lots*

Parcel Number

Project Site Owner*

Contact Name*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

FAX

Email*

Plan Preparer Name*

Company Name*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

FAX

Email*

Contractor/Builder Contact*

Phone*

Site Erosion Control Supervisor*

Phone*

Cell Phone

FAX

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Submit Files of the Following or Provide Physical Copies to Our Office:

- Construction Plans including Plat and Legal Description
- Copy of Stormwater Pollution Prevention Plan for Construction Sites
- Copy of Post-Construction Stormwater Pollution Prevention Plan, with calculations if applicable
- Copy of LaPorte County Application for Erosion and Sediment Control Permit (this form)
- Copy of Post Construction Operations and Maintenance Manual
- Copy of Proof of Publication of Notice of Intent in Local Newspaper

Drop files here or

Max. file size: 48 MB.

Site Development Per Acre Fee

Site Development Fee:

Site Development Fee: $150/disturbed acre of soil. Please remit check payable to LaPorte County MS4.

Signature*