Editor's Note: Appendix B is available in PDF, click HERE
Application Number ___________________
STORMWATER MANAGEMENT
APPLICATION & PERMIT
STORMWATER MANAGEMENT RULES & REGULATIONS
Village of Bellville, Ohio
1. Applicant Name: _______________________________________________________________
Street Address: ________________________________________________________
City, State, Zip: _______________________________________________________
Telephone: ____________________________________________________________
2. Property Location
Street Address or Lot No.: ______________________________________________
City or Village:________________________________________________________
Section:_________________________ Township:____________________________
Owner’s Name_________________________________________________________
Street Address:________________________________________________________
City, State, Zip:_______________________________________________________
Property Size (Acres):__________________________________________________
3. Description of nonfarm earth-disturbing activity to be performed on the above property:_______
____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
Area to be disturbed (Square Feet):___________________________________________________
Area to be rendered impermeable (Square Feet):________________________________________
4. Attach a site plan and any other additional information (i.e., lot survey, and the like), that you have available that might help depict your intention and how the end product of this activity will look.
5. I, the undersigned, being responsible for the above described earth-disturbing activity, understand that the activity is subject to and must comply with the Stormwater Management Rules and Regulations of the Village of Bellville, Ohio.
Signature:____________________________________________________________________
Title (Owner, Developer, other):__________________________________________________
Street Address:________________________________________________________________
City, State, Zip:_______________________________________________________________
Date: _______________________________________________________________________
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PERMIT FEE OF $25 MUST ACCOMPANY APPLICATION
******************
FOR OFFICIAL USE ONLY
The above application has been reviewed and the applicant has been:
Permit issued
No permit required
Advised that a Stormwater Management Plan must be submitted, reviewed, and approved prior to the issuance of a permit on ________________________.
Advised that a Drainage Plan must be submitted, reviewed, and approved prior to the issuance of a permit on _____________________________________.
Advised that there is an existing approved Stormwater Management Plan for this site that must be complied with.
Advised that no plan is required, but applicant is not exempt from compliance to the regulations.
_________________________________________________________
Village Administrator
_________________________________________________________
Date
COMMENTS:
(Ord. 16-96, passed 4-15-1996)