Fillable Make check payable to: Augusta-Richmond County Planning Commission@ (City of Augusta)

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Make check payable to: Augusta-Richmond County Planning Commission@ (City of Augusta)

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National Pollutant Discharge Elimination System
General Permit Fee Form
Please print or type this form.
Submit original and payment to:
Augusta-Richmond County Planning Commission
535 Telfair Street, Suite 300
Augusta GA 30901
Make check payable to: Augusta-Richmond County Planning Commission@
Primary Permittee:
Project Name:
Address:
Location:
Acres disturbed = ________
@ $55 per acre
$ __________
Check Number
Enclosures
Copy of Notice of Intent
Copy of check to GA DNR-EPD
Submitted By:
Signature: Date :
Print Name: ________________________________Title: _______________________________
ATTACH CHECK HERE
VOID IF SUBMITTED WITHOUT PAYMENT
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Make check payable to: Augusta-Richmond County Planning Commission@ (City of Augusta)

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Completed 12 February 2021

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