Fillable APPLICATION GRADING PERMIT City of Prattville Annex Building (City of Prattville)

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APPLICATION GRADING PERMIT City of Prattville Annex Building (City of Prattville)

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APPLICATION – GRADING PERMIT
City of Prattville Annex Building
102 W. Main Street, Prattville, Alabama 36067
(334)595-0400, FAX (334)361-3677, building@prattvilleal.gov
Page 1 of 2
Property Location and General Information
Project Name:
Site Location / Address:
Subdivision: Lot: Block:
Tax Parcel ID:
Description of Work & Proposed Use:
Disturbed Area
(Acres):
____________
Type of Permit:
☐ Grading and/or Earthwork
☐ Clearing On
ly
Type of Project:
☐ One or Two Family Resident
ial (Single Lot)
☐ All Other Construction (Development)
Owner Contact Information
Property Owner: Company:
Address:
City: State: Zip Code:
E-mail: Phone:
Site Supervisor Contact Information
Site Supervisor: Company:
Address:
City: State: Zip Code:
E-mail: Phone:
QCP Contact Information
QCP: Company:
Address:
City: State: Zip Code:
E-mail: Phone:
Regulatory Requirements
NPDES Permit Required? ☐ Yes ☐ No
NPDES Permit No.:
CBMP Plan Attached? ☐ Yes ☐ No
CBMP Narrative Included? ☐ Yes ☐ No
Standard ESC Details Used?
☐ Yes ☐ No
Standard ESC Details Attached? ☐ Yes ☐ No
Notes:
Esitmated Bond
Amount:
_____________
APPLICATION – GRADING PERMIT
City of Prattville Annex Building
102 W. Main Street, Prattville, Alabama 36067
(334)595-0400, FAX (334)361-3677, building@prattvilleal.gov
Page 2 of 2
Certification
AMEND APPLICATION, TRANSFER GRADING PERMIT:
An approved Grading Permit shall not expire unless there are changes to the project which may affect the quantity
and/or quality of storm water runoff. Grading Permits may be amended or transferred according to Article 1, Division
1, Section 10 of the City of Prattville Illicit Discharge Detection and Elimination (IDDE) Procedures Ordinance.
RIGHT OF ENTRY:
I hereby grant designated officials of City of Prattville the right to enter my property for the purpose of inspection or
monitoring for compliance with the approved erosion and sediment control plan on the above referenced project.
PLAN IMPLEMENTATIONS:
I certify that I fully understand and will comply with all City of Prattville Erosion and Sediment Control Program
requirements and the
Alabama Handbook for Erosion, Sediment Control and Stormwater Management on
Construction Sites or industry standards as accepted by ADEM. I will carry out the erosion and sediment control plan
on the above referenced project as approved by the City of Prattville. I will keep a copy of the most current Alabama
Handbook or field manual and one set of the approved Erosion Control Plan on the referenced site at all times.
Owner and Applicant Signatures
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision,
and I am familiar with, the information in this document and such attachments. Based on my inquiry of those individuals
immediately responsible for obtaining the information or of the Qualified Credentialed Professional responsible for
preparing any portion of the application or correspondence, I believe the submitted information is true, accurate and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of
fine and civil penalty.
_______________________________ _______________________________ ______________
Printed Name and Title of Applicant Signature of Applicant Date
_______________________________ _______________________________ ______________
Printed Name and Title of Owner Signature of Owner (Required) Date
For City Use Only
Permit Number:
Project Approved? ☐ Yes ☐ No
_______________________________ ___________________
Print Name of Approver Department
_______________________________ ___________________
Signature of Approver Date
Date:
Fee:
Bond/Check Amount:
Bond/Check Number:
Note: Shaded portion for City of Prattville use only
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APPLICATION GRADING PERMIT City of Prattville Annex Building (City of Prattville)

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Completed 24 February 2021

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