Ashland City Fire, Building &
Life Safety Department
101 Court Street
Ashland City TN 37015
Fire & Life Safety: (615) 792-4531 – Building Codes (615) 792-6455
Permit No.____________
Approved by:_________
Date:________________
Application for Grading Permit
Permit Fee: $100
This permit becomes null and void if work or construction authorized is not commenced within 6
months, or if construction or work is suspended or abandoned for a period of 6 months at any time
after work is commenced.
Property
Owner
Information
Business Name:__________________________________________________
Property Owner: _________________________________________________
Property Owner Address: _______________________________ Zip: ________
City/State: ______________________________County: __________________
Contact Phone #:_________________
Property Address/Location (if different than above): ______________________
_______________________________________________________________
Contractor: ______________________________________________________
Contractor Address: _______________________________________________
City/State: _________________________________________ Zip___________
Contact Phone #: _________________
Onsite Contact Name and Phone #: ___________________________________
Person responsible for Erosion Control:______________________________
Total area (acres or square feet): ___________________________________
Area to be disturbed (acres or square feet):___________________________
Schedule of work (start & estimated completion dates):__________________
1. I agree that I will comply with all ordinances, laws and Town of Ashland City policies
regulating grading, land disturbances, erosion/sedimentation control and storm water
management.
2. I agree to allow access to said activities for inspection by the Town of Ashland City personnel.
3. All erosion/sedimentation control measures will be installed pre-SWPPP plan before land
disturbing activities. I further agree to add any additional erosion/sedimentation control
measures as requested by the Town of Ashland City.
4. I agree that I will be responsible for any damage to any utilities, public right-of-ways and city
streets caused by this work
Total Cost for ALL grade work and infrastructure to be installed: _________________________
_______________________________________
Applicant Signature Date
_______________________________________
Building Inspector Signature Date
