STORMWATERPERMITAPPLICATION
278GreenbagRoad◊PostOfficeBox852◊Morgantown,WV26507‐0852◊304‐292‐8443◊Fax304‐292‐1526
Revised1‐26‐15
PERMITINFORMATION(PleasePrintClearlyorType):
ApplicantName: Address:
City: State: Zip:
OfficePhoneNo.: HomePhoneNo.: CellPhoneNo.:
E‐MailAddress:
1. PROJECTINFORMATION:
Single
Family
Dwelling
Other
(multifamily,
Comm.,Industrial,
Parking,Etc.)
SitePlan
Attached
StormWater
ManagementPlan
Attached
SedimentationandErosion
ControlPlanAttached
2. TYPEOFCONSTRUCTION:
House Multifamily Comm./Indust. Parking Other(PleaseExplainin#7)
3. PROJECTADDRESS:
StreetAddress: City: State: Zip:
4. LOTSURFACECOMPOSITION:
A. PreNon‐Impervious:_______Sq.Ft. B. PostNon‐Impervious:________Sq.
Ft.
C. PostImpervious:________Sq.Ft.
D. PreImpervious:_________Sq.Ft. E. TotalSiteArea:________Sq.Ft. F. PercentImpervious:______%
*ALLGRAVELSUBJECTTOVEHICLETRAFFICSHALLBECONSIDEREDIMPERVIOUS.
5. CONTRACTORINFORMATION:
Contractor: SiteRepresentative:
StreetAddress:
City: State: Zip:
Phone(Ofc): Phone(Cell): Email:
6. DEPApprovalRequired:1‐3Acres–NOI;3+Acres – WVDEPConstructionStormwaterPermit
YesorNo: IfYesprovidedcopy:
7. ADDITIONALINFORMATIONABOUTPROJECT(PleaseExplainindetail):
PrintedName: Signature(Required): Date:
PROJECTEVALUATION(ForOfficeUseOnly):
PROJECTREQUIREMENTS:
SedimentationandErosionControl StormWaterManagementPlan Other(SeeComments)
ROOFDRAINS/DISCHARGEPIPESHALLCONNECTTO:
Ext.StormLine DryWell Ditch Stream Ground Other(SeeComments)
WATERSHEDINFORMATION
ReceivingStream: ImpairmentorTMDL:
COMMENTS:
ServiceNo.: PermitNo.: DateReceived:
ReviewedBy: DateReviewed: