STORMWATER DESIGN
WAIVER REQUEST FORM
The City of Grove City recognizes unique circumstances could exist to prevent the designer’s ability to adhere to all design
practices specified in the Stormwater Design Manual. This Stormwater Design Waiver Request Form shall be used to
describe the designer’s legitimate need for a variance.
Revised 5/2019
City of Grove City
Public Service Department
4035 Broadway
Grove City, OH 43123
614-277-1100 (Phone)
614-277-1112 (Fax)
GroveCityOhio.gov
PROJECT INFORMATION
Project Name ________________________________________________________ Submission Date ________________________________
DESIGNER INFORMATION
Name/Company Name _______________________________________________ Phone ___________________________________________
Address _____________________________________________________________ Email ____________________________________________
A DESIGNER MAY REQUEST A WAIVER BY PROVIDING THE FOLLOWING:
o A signed, completed Stormwater Design Waiver Request Form with a written explanation, describing the
reason compliance is considered a hardship.
o Two detailed designs: • ONE illustrating compliant design; and
• ONE illustrating proposed design.
o If the waiver request is based on economic hardship, cost estimates for both designs shall be submitted.
OFFICE USE
APPROVED
NOT APPROVED
DATE _______________
STATEMENT OF HARDSHIP
I, __________________________________________________________ (Designer/Responsible Party of referenced Project),
certify that a justifiable hardship exists, inhibiting my ability to adhere to all standard design practices.
_____________________________________________________________ ___________________________________________
SIGNATURE DATE
o
o
Falsification of a public document is a violation of the Ohio Revised Code, section 2921.13(a)(3), a misdemeanor of
the first degree, punishable by up to six months imprisonment and a fine of one thousand dollars ($1,000.00) or both.
The City will review the request, issuing a decision within two weeks of submission and reserves the right to request additional information.
Comments: __________________________________________________________
__________________________________________________________
__________________________________________________________
