Application For Stormwater Permit

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

Fee Schedule
Tier 1: Area of Disturbance 10,000 sq ft up to 1 acre and within 50 feet of a waterway – base fee $400
Tier 2: 1 acre up to 20 acres – base fee $600 plus $150/acre for every acre of disturbance greater than 1 acre
Tier 3: Area of Disturbance 20 acres up to 40 acres – base fee $3,450 plus $100/acre for every acre of disturbance greater than 20 acres
Tier 4: Area of Disturbance 40 acres up to 80 acres – base fee $5,250 plus $75/acre for every acre of disturbance greater than 40 acres
Tier 5: Area of Disturbance greater than 80 acres – base fee of $8,250 plus $50/acre for every acre of disturbance greater than 80 acres

Project Site Owner

Project Site Owner*

Contact Name*

Phone*

FAX

Email*

Plan Preparer

Plan Preparer Name*

Company Name*

Phone*

FAX

Email*

Contractor/Builder Contact*

Phone*

Site Erosion Control Supervisor*

Phone*

Cell Phone

FAX

Email*

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.