Fillable City of Rockford, Illinois (CITY OF ROCKFORD)

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City of Rockford, Illinois (CITY OF ROCKFORD)

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File type: PDF

U.S.A. forms for CITY OF ROCKFORD

BROWSE CITY OF ROCKFORD (IL) FORMS

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City of Rockford, Illinois
Public Works Department
Engineering Division
425 E State St, Rockford IL 61104
Phone: (779) 348-7174 Fax: (815) 967-7058
Website: rockfordil.gov
Permit Fee:
Invoice Number:
PW Clearance:
Date:
Permit Number:
STORMWATER MANAGEMENT PERMIT APPLICATION
Project Name:
Site Address/Location:
This is a: ☐Subdivision Development ☐Building Site ☐Parking Lot ☐Other
Description of Work:
Date to Begin Work:
Date of Completion:
** If work does not commence within 2 weeks of the listed start date this permit is no longer valid until the City of
Rockford is informed of the new start date. Permit is valid for two (2) years from date construction commences.
Projects that extend beyond 2 years from the start date shall submit a new permit application and applicable fees.
Owner of Record:
Phone #:
(Address)
(City)
(State)
(Zip)
Developer:
(if different from owner)
Phone #:
(Address)
(City)
(State)
(Zip)
Engineer/ Surveyor of Record:
Phone #:
(Address)
(City)
(State)
(Zip)
List below the party responsible for construction and maintenance of all drainage ditches, storm water storage areas, erosion
& sediment control measures, etc. throughout the course of construction.
Name:
Phone #:
(Address)
(City)
(State)
(Zip)
City of Rockford, Illinois
Public Works Department
Engineering Division
425 E State St, Rockford IL 61104
Phone: (779) 348-7174 Fax: (815) 967-7058
Website: rockfordil.gov
Permit Fee:
Invoice Number:
PW Clearance:
Date:
Permit Number:
List below the party responsible for permanent maintenance of drainage ditches, storm water storage areas, erosion &
sediment control measures etc.
Name:
Phone #:
(Address)
(City)
(State)
(Zip)
Responsible Party is: ☐Property Owner ☐Homeowner’s Assoc. ☐Leasee of Property ☐Other
Specify:
Signature:
Printed
Name:
Date:
**If any BMP requires long term maintenance, a Post Construction Management Plan shall be completed and submitted.
**All applicable best management practices for erosion & sediment control must be installed prior to the start of grading.
Contact Brad Holcomb at (779) 348-7611 or brad.holcomb@rockfordil.gov a minimum of 48 hours prior to the start of any
land disturbing activities to arrange for a Pre-Grading Inspection. A Pre-Grading Inspection shall be required for any
project that is adjacent to an environmentally sensitive area (i.e., floodplain, creek, natural habitat, etc.).
For Office Use Only
Watershed:
Section:
Township:
Range:
PIN #:
IEPA Permit #:
Is site in a Special Flood Hazard Area? ☐ No ☐ Yes
If Yes, has Floodplain Permit been submitted? ☐ No ☐ Yes
Does the Tentative Plat Apply? ☐ No ☐ Yes
If Yes, has it been submitted? ☐ No ☐ Yes
Does the Grading Plan Apply? ☐ No ☐ Yes
If Yes, has it been submitted? ☐ No ☐ Yes
Is Site Over 1 Acre of Disturbance? ☐ No ☐ Yes
If Yes, has SWPPP & ES&C Plan been submitted? ☐ No ☐ Yes
If Yes, has NOI been submitted to IEPA? ☐ No ☐ Yes
Does the Post Construction Management Plan Apply? ☐ No ☐ Yes
If Yes, has it been submitted? ☐ No ☐ Yes
Is site adjacent to an Environmentally Sensitive area? ☐ No ☐ Yes
If Yes, has pre-grading inspection been scheduled? ☐ No ☐ Yes
Has site been surveyed for Endangered Species?? ☐ No ☐ Yes
If Yes, has survey been submitted? ☐ No ☐ Yes
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City of Rockford, Illinois (CITY OF ROCKFORD)

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Completed 25 February 2021

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