2016-04-26_PWETC_AgendaPacket - Laserfiche WebLink

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Attachment G l� EROSION CONTROL &STORMWA TER PERMIT JL ❑ Erosion Control ❑Stormwater Permit No: APPLICATIONDATE: SITE: Address/Location: APPLICANT: Company: Daytime Phone: Address: Email: City/State/Zip: Contact Person: Applicant Signature: ESCROW DEPOSIT FROM: Name: Address: City/State/Zip: The applicant assumes all responsibilities for installation and maintenance of the erosion control on this site. Any problems identified by the City erosion control inspector shall be addressed within 48 hours of notification. The applicant understands that failure to install and maintain erosion control within the time allotted will result in the City using escrow funds to remedy deficiencies and for additional staff time. The issuance of this permit constitutes a right-of-entry for the City or its contractor to enter upon the construction site for the purpose of completing the corrective work. As Property Owner I further agree and understand that in the event that there are insufficient escrow funds,the cost for the work will be billed to the applicant. If payment is not made in full within 30 days of receiving the bill,the unpaid amount will be assessed to my property taxes,together with any additional administrative charges and interest(5%)of the unpaid amount. By signing this application I authorize the City of Roseville to certify to my property taxes any unpaid costs,together with additional administrative charges and interest.I understand that this authorization constitutes and is intended to be a full and complete waiver of any notice,hearing,irregularity,appeal,or any other rights that might otherwise apply to the City's imposition of costs or assessments under this permit. OWNER Name: Daytime Phone: Address: Email: City/State/Zip: Contact Person: Property Owner Signature: PERMIT FEES Number of Acres: Permit Fees,for 1 ear circit 9e Less than 1 acre = $625.00 1-5 acres= $900.00 Over 5 acres= $1,400.00 Escrow Fees: $3,000.00 x number of acres $ Permit Renewal Fees' circle one Less than 1 acre = $220.00 1-5 acres= $320.00 Over 5 acres= $480.00 POR OFFICE tfSE 01'LY Amount Paid: Date Paid: Initials: Original Permit Number if applicable): Fees adopted 11/22/10 Please call 651-792-7004 to schedule a site inspection meeting before beginning construction. Engineering Dept*2660 Civic Center DraRoseville,MN 55113 + Phone: 651-792-7004 *FAX: 651-792-7040