9.13.23 BOA Agenda Packet - Laserfiche WebLink

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EVALUATIONK SITE ' • • # 186 ❑IMPROVEMENT PERMIT FOR AN INDIVIDUAL LOT(Up to 600 GPD) S 310 PER SITE ❑IMPROVEMENT PERMIT FOR A SUBDIVISION I RECOMBINATION OF PROPERTY(Up to 600 GPD): NUMBER OF SITES IN SUBDIVISION I RECOMBINATION: S 310 PER SITE ❑SITE REVISIT TO REISSUE OR MODIFY A VALID IMPROVEMENT PERMIT(Up to 600 GPD) $100 PER SITE EACH SITE EVALUATION CONSISTS OF UP TO 2 ACRES FLOWS OVER 600 GPD REQUIRE ADDITIONAL FEES -ME0mT THE FOLLOWING ARE REQUIRED BEFORE PROCESSING THIS APPLICATION_FOR AN IMPROVEMENT PERMIT: O A SITE PLAN OR PLAT SHOWING THE EXISTING AND PROPOSED PROPERTY LINES WITH DIMENSIONS AND THE LOCATION OF ALL PROPOSED STRUCTURES,ADDITIONS,OR IMPROVEMENTS WITH LABELED SETBACKS. O EXISTING AND ANY PROPOSED PROPERTY LINES 1 CORNERS MUST BE CLEARLY MARKED ON SITE. O THE APPLICANT IS RESPONSIBLE FOR MAKING THE SITE ACCESSIBLE FOR THE EVALUATION. O FOR NON SINGLE FAMILY DWELLING APPLICATIONS,ADDITIONAL INFORMATION TO DETERMINE WASTE FLOW AND CHARACTERISTICS WILL BE REQUIRED. [IF CONSTRUCTION • ' • • # ❑AUTHORIZATION TO CONSTRUCT FOR NEW CONSTRUCTION S 160(Up to 600 GPD) ❑SITE REVISIT TO REISSUE OR MODIFY A VALID CONSTRUCTION AUTHORIZATION S 100(Up to 600 GPD) Cm THE FOLLOWING ARE REQUIRED BEFORE PROCESSING THIS APPLICATION FOR A CONSTRUCTION AUTHORIZATION: O A FLOOR PLAN OF THE STRUCTURE MUST BE SUBMITTED. O A SITE PLAN OR PLAT,MUST BE PROVIDED SHOWING:THE LOCATION OF THE PROPOSED STRUCTURES, DRIVEWAYS,ADDITIONS,EXCAVATIONS OR OTHER IMPROVEMENTS;PROPERTY LINTS;DIMENSIONS;AND SETBACKS TO REFERENCE POINTS. O THE EXISTING AND ANY PROPOSED PROPERTY LINES 1 CORNERS MUST BE CLEARLY MARKED ON SITE. O THE LOCATION OF PROPOSED STRUCTURES AND IMPROVEMENTS MUST BE STAKED ON SITE. THE CONSTRUCTION AUTHORIZ477ON MUST BE ISSUED PRIOR TO ANY CONSTRUCTION. SUBSEQUENT CHANGES TO THE SITE PLAN,FLOOR PLAN,OR APPLICATION WILL REQUIRE ANEW APPLICATION AND ADDITIONAL FEES. FLOWS OVER 600 GPD REQUIRE ADDITIONAL FEES. SIGNATURE 2) • ❑ TOTAL AMOUNT DUE s y r RECEIPT# 3 Q 3 t✓ ADDITIONAL FEES MAY BE REQUIRED IF THE RESULTING FLOW IS_>600 GPD,FOR NON-DOMESTIC WASTEWATER SYSTEMS. OR IF ADDITIONAL PERMITS ARE NECESSARY THIS APPLICATION MUST BE SIGNED BY THE CURRENT OWNER OF THE PROPERTY OR THE OWNER'S LEGAL REPRESENTATIVE(eg.SPOUSE,POWER OFATTORNEY,EXECUTOR,OR PERSON WHO HAS ENTERED INTO A CONTRACT OR LEASE WITH THE PROPERTY OWNER) J ONLY ORIGINAL SIGNATURES CAN BE ACCEPTED. 1 AM THE PROPERTY OWNER OR THE PROPERTY OWNERS LEGAL REPRESEMATIVE y I HAVE READ THIS APPLICATION AND AUTHORIZE THE OCHD TO ENTER THE PROPERTYAND PERFORM THE SERVICE(S)REQUESTED. OWNEIL DATE: Z b 3 a