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Stormwater Forms

VILLAGE OF WESTVILLE

 

DRAINAGE AND GRADING PERMIT/APPLICATION

 

 

Project Name                                                                                                             

Project Address                                               (If no address, attach legal description)  

This application is for one of the following:        Grading/Fill Only   Site Development

 Development of entire project                       Development of Phase(s)          of          

 Subdivision Development                                        Area of Site          (acres or square feet)

Note: Any changes in or expanded scope of that represented herein will necessitate submittal of a revised plan and application.

 

Note:  (a)      Westville, Illinois, Stormwater Management Regulations (Ordinance No.     ) require that positive stormwater run-off and erosion control measures must be taken during construction of any stormwater management facility.

          (b)      Any stormwater management facility for which a permit has been issued as a part of a subdivision improvement plan must be included with as-built drawings and certified to have been constructed accordingly.

          (c)      Any stormwater management facility for which a permit has been individually or as part of a site development plan must be certified to have been constructed in conformance with the approved drawings prior to issuance of an occupancy permit.

          (d)      A DNR Land Disturbance Permit is required for construction sites of 1 acre or more in area.

 

APPLICANT/OWNER:                                        CONTRACTOR

 

Name                                                             Name                                                  

Firm                                                                Firm                                                     

Address                                                          Address                                               

                                                                                                                                 

Phone                      Fax                                  Phone                      Fax                       

E-mail                                                             E-mail                                                  

 

PROFESSIONAL ENGINEER

 

Name                                                             Firm                                                     

Address                                                          Phone                                                  

E-mail                                                             Fax                                                      

 

Brief description of work to be performed: (Attach plans)                                             

                                                                                                                                 

 

Permit Fee:   $200 if Article III – Stormwater Drainage and Detention is applicable

                    $25 All others

 

I, the undersigned, do hereby state that I have read and fully understand the provisions of this application and further, by my signature, I hereby agree to maintain compliance with the Village of Westville Stormwater Management Regulations.  I certify that any land clearing, construction, or development involving the movement of earth shall be in accordance with the plans approved upon issuance of the permit.

 

Signature of Applicant                                                         Date                                

 

FOR OFFICE USE ONLY

 

NOTES AND/OR CONDITIONS                                                                                     

                                                                                                                                 

 

Received by             (initial)        Filing Fee                          Date                                

Reviewed by                     Engineering              (initial)        Planning                (initial)

COPIES TO:             Engineering             Inspection Services            Drainage Permit Fee

 

APPROVED BY                                                                     Date