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❑IMPROVEMENT PERMIT FOR AN INDIVIDUAL LOT(Up to 600 GPD) $310 PER 5FI'E <br /> ❑IMPROVEMENT PERMIT FOR A SUBDIVISION 1 RECOMBINATION OF PROPERTY(Up r0 600 GPD): <br /> NUMBER OF SITES IN SUBDPaSION 1 RECOMBINATION: $310 PER SITE <br /> ❑SITE REVISIT TO REISSLT OR MODIFY A VALID IMPROVEMENT PERMIT(Up to 600 GPD) $ 100 PER SITE <br /> E4CH SITE EV4LU_4TI0N CONSISTS OF UP TO 2 ACRES. FLOWS OVER 600 GPD RE E,7RE_4DDITTON.4L FEES <br /> cglcgm THE FOLLOWING ARE REQUIRED BEFORE PROCESSING THIS APPLICATION FOR AN <br /> IMPROVEMENT PERMIT: <br /> 0 A SITE PLAN OR PLAT SHOWING THE EXISTING AND PROPOSED PROPERTY LINES WITH DIMENSIONS AND <br /> THE LOCATION OF ALL PROPOSED STRUCTURES,ADDITIONS,OR IMPROVEMENTS WITH LABELED <br /> SETBACKS. <br /> 0 FISTING AND ANY PROPOSED PROPERTY LINES 1 CORNERS MUST BE CLEARLY MARKED ON SITE. <br /> O THE APPLICANT IS RESPONSIBLE FOR MAKING THE SITE ACCESSIBLE FOR THE EVALUATION- <br /> 0 FOR NON SINGLE-FAMILY DWELLING APPLICATIONS,ADDMONAL INFORMATION TO DETER4VIINE WASTE <br /> FLOW AND CHARACTERISTICS WILL BE REQUIRED- <br /> CONSTRUCTION <br /> AUTHORIZATION SECTION <br /> ❑ AUTHORIZATION TO CONSTRUCT FOR NEW CONSTRUCTION $ ISO(4 to 600 MD) <br /> ❑SITE REVISIT TO REISSUE OR MODIFY A VAUD CONSTRUCTION AUTHORIZATION 5100(Up to 600 GPD) <br /> THE FOLLOWING ARE REQUIRED BEFORE PROCESSING THIS APPLICATION FOR A <br /> CONSTRUCTION AUTHORIZATION; <br /> O A FLOOR FLAN OF THE STRUCTURE MUST BE SUBAE[TTED_ <br /> D A SITE PLAN OR PLAT MUST BE PROVIDED SHOWUgG:THE LOCATION OF THE PROPOSED STRUCTURES, <br /> DRIVEWAYS,ADDITIONS,EXCAVATIONS OR OTHER IMPROVE MNTS;PROPERTY LINES;DIMENSIONS; AND <br /> SETBACKS TO REFERENCE POINTS. <br /> ❑ THE EXISTING AND ANY PROPOSED PROPERTY LINES I CORNERS MUST BE CLEARLY MARKED ON SITE. <br /> O THE LOCATION OF PROPOSED STRUCTURES AND IMPROVEMENTS MUST BE STAKED ON SITE. <br /> THE CONSTRUCTION AUTHORIZATION MUST BE ISSUED PRIOR TO ANY CONSTRUCTION. SUB SE UENT CHANGES <br /> TO THE SITE PLAN FLOOR PLAN OR APPLICATION WILL RE WRE ANEW APPLICATION AND ADDITIONAL FEES; <br /> FLOWS OVER 600 GPD REQUIRE ADDITIONAL FEES. <br /> SECTIONSIGNATURE <br /> Cl TOTAL AMOUNT DUE s RECEIFT# <br /> ADDITIONAL FEES MAY BE UIRED IF THE RESULTING FLOW IS>600 GPD FOR NON-DOMESTIC WASTEWATER <br /> SYSTEMS OR IF ADDITIONAL PERMITS ARE NECESSARY <br /> THIS APPLICATION MUST BE SIGNED BY THE CURRENT OWNER OF THE PROPERTY OR THE OWNER'S LEGAL <br /> REPRESENTATIVE(eg. SPOUSE, POWER OFATTORNFY, EXECUTOR, OR PERSON WHO HAS ENTERED INTO A <br /> CONTRACT OR LEASE WITH THE PROPERTY OWNER) <br /> ONLY ORIGINAL SIGNATURES CAN BE ACCEPTED. <br /> I AM THE PROPERTY OWNER OR THE PROPERTY OWNERS LEGAL REPRESENTATNE <br /> I HAVE READ THIS APPLICATION AND AUTHORrZE THE OCHD TO ENTER THE PROPERTY AND PERFORM THE <br /> SERVICE(S)REQUESTED. <br /> 1 <br /> OWNER: DATE: <br /> 229 <br />