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receive StormWatel' runoff discharges, make a brief sLn-vey of the project's surrounding area. Include the waters identified
<br />on a USGS 7.5 -minute quad or equivalent map. See Appendix A of this permit to determine if a water body is a special
<br />water. To find special or impaired waters, use the Special and Impaired Waters Search tool at:
<br />www.pca.state.nul.us/water/stormwater/stormwater-c.html.
<br />13. List the start and estimated completion dates of the construction project (for example, 9/18/05),
<br />Responsible Parties
<br />14. Owner information: Provide the information requested of the owner of the company, organization, or other entity for
<br />Which this conSIRIC6011 project is being done. The Owner means the person or party possessing the title of the land on
<br />which the construction activities will occur; or if the construction activity is for a lease holder, the party or individual
<br />identified as the lease holder; or the contracting government agency responsible for the construction activity. The owner
<br />is the party responsible for the compliance with all terms and conditions of the permit. The alternate contact
<br />should be the owner's representative in charge of the project (for example, Sandy Smith, Inspector; Joe Johnson, Project
<br />Manager; etc).
<br />After completing this application, certify it with a signature and date fi-om an individual authorized to sign the
<br />application. This application form must be signed by either a principal executive officer, vice president, representative
<br />agent responsible for overall operations, general partner, or a proprietor. If the activity is being conducted by a unit of
<br />government (state, county, municipality, or township), this application must be signed by a principal executive officer or
<br />ranking elected official (for example, city or county engineer, administrator, or manager; director of public works;
<br />mayor, etc.) For additional information, see Minnesota Rules 7001.0060.
<br />15, Contractor (Operator) Information. Provide the information requested of the contractor. The Contractor means the
<br />party who signs the construction contract with the owner to construct the project described in the final plans and
<br />specifications. Where the construction project involves more than one contractor, the general contractor will be the party
<br />responsible for managing the project on behalf of the owner. In some cases the owner may be the general contractor. In
<br />these cases, the owner may contract an individual as the operator who would be the co -permittee. The operator (usually
<br />the general contractor) is jointly responsible with the owner for compliance with part i1.B., part II.C., and part iV
<br />of the permit.
<br />After this application has been completed by the owner, the contractor must certify it with a signature and date from an
<br />individual authorized to sign the form. The application must be signed by either a principal executive officer, vice
<br />president, representative agent responsible for overall operations, general partner, or a proprietor. If the general contractor
<br />is a unit of government (state, county, nurnicipality, or township), this application must be signed by a principal executive
<br />officer, ranking elected official, administrator, manager, coordinator, or engineer. (For additional information, see
<br />Minnesota Rules 7001.0060.) The alternate contact should be the contractor's representative in charge of the project (for
<br />example, Scott Marshall, Head Foreman; Ann Johnson, Project Manager, etc.).
<br />Send the completed application and fee to:
<br />MPGA
<br />Regional Environmental Management Division
<br />520 Lafayette Road North
<br />St. Paul, MN 55155-4194
<br />Onestions? Contact the N1PC4 Customer Assistance Center at (800) 646-6247 or (651) 197-1174.
<br />For businesses frith Rice r than 100 emplolves, content the A11PCA Small Business assistance Program at (800) 657-3938.
<br />\vq-s1mi2-58 Revised 11/06
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