Revised 01/16/17
Department of Community
and Economic Development
100 N. Jefferson Street, Rm 608
Green Bay, WI 54301-5026
(920) 448-3300 - phone
(920) 448-3426 - fax
inspmail@greenbaywi.gov
Small Site General Instructions: Submit this application and erosion control plan demonstrating compliance with Ch. 34,
Green Bay Municipal Ordinance and/or Ch. SPS 321.125, Uniform Dwelling Code, for sites covering less than one acre and/or one-
or two-family residential construction prior to commencing land-disturbing construction or land-development activity to Room 610.
Large Site General Instructions: Submit application and erosion control plan demonstrating reasonable compliance with Ch. 34, Green
Bay Municipal Ordinance, for sites one acre or greater in size prior to commencing land-disturbing construction or land-development
activity to Room 610.
Excavation within Public Rights-Of-Way General Instructions: Submit this application and erosion control
plan demonstrating compliance with Ch. 34, Green Bay Municipal Ordinance for land disturbances covered within section 34.04(1)
(a) 1. 4,000 SF; 4. 100 LF of drainage conveyance impacts; 6. 300 LF of underground utility work; and/or 7. 100 CY or
greater of excavation volume prior to commencing land-disturbing construction or land-development activity to Room 300.
Address/Street of land-disturbing activity:
Parcel #:
Zoning District: Project #:
Site #
APPLICANT
Property Owner
General Contractor
EROSION CONTROL CONTRACTOR
Name Name
Company Company
Address Address
City, State, Zip City, State, Zip
Phone Phone
Email Email
Description of Activity:
Start
End ______________
Erosion Control Plan: (provide 3 copies) *Must demonstrate compliance with Ch. 34, Green Bay Municipal Ordinance and/or Ch. SPS 321.125
UDC, including but not limited to all of the following:
1. Application
2. Property legal description
3. Existing site map / plan
4. Final site map / plan
5. Site construction plan
6. Soil loss prediction tool / spreadsheet
7. Erosion & Sediment Control Plan Statement (Narrative description of who, what,
when, where, how things will be completed on the proposed site(s)).
Applicant Signature: ______________________________________________________________________ Date: ________________________
Following sections to be completed by the City of Green Bay
Plan Approval: Permit is void unless signed by the Erosion Control Specialist.
Erosion Control Plan reviewed and approved by Erosion Control Specialist:___________________________________ Date:____________________
Permit Issuance:
1. Duration – This erosion control permit shall remain valid for a period of 180 days or for the length of the building permit, whichever is longer. The
Erosion Control Specialist or designated representative may extend the period one or more times for up to an additional 180 days, and may require
additional erosion control measures as a condition of the extension if necessary to meet the requirements of this ordinance.
Permit Expiration Date: __________________________________
2. Surety Bond - As a condition of approval and issuance of the permit, the Public Works Director may require the applicant to deposit a surety bond or
irrevocable letter of credit to guarantee a good faith execution of the erosion control plan.
Surety Bond Amount $ __________________________________ Date Filed: _______________________________________
3. Conditions of Approval - This permit approval requires the applicant to:
a. Notify the Erosion Control Specialist / designated representative at least 48 hours before commencing any land-disturbing construction or land-
development.
b. Notify the Erosion Control Specialist / designated representative of completion of any erosion control measures within seven days after their
installation.
c. Obtain permission in writing from the Erosion Control Specialist / designated representative prior to modifying the erosion control plan.
d. Install all erosion control measures as identified in approved erosion control plan.
e. Maintain all road drainage systems, storm water drainage systems, control measures, and other facilities identified in erosion control plan.
f. Repair any siltation or erosion damage to adjoining surfaces and roadways resulting from land-developing construction or land-disturbing activities.
g. Inspect the construction erosion control measures after each rain of 0.5" or more and at least once each week and make needed repairs.
h. Allow the Erosion Control Specialist / designated representative to enter the site for the purpose of inspecting compliance with the erosion
control plan or for performing any work necessary to bring the site into compliance with the erosion control plan.
i. Keep a copy of the approved erosion control plan on the site.
j. Submit weekly inspection reports to the Erosion Control Specialist via e-mail at erosioncontrol@greenbaywi.gov
Failure to comply with any of these conditions may subject the permittee to corrective action, fines, and/or revocation of the permit at
permittees sole expense.
Permit Issued By: __________________________________________ Date:___________________________________
EROSION CONTROL
PERMIT APPLICATION
www.greenbaywi.gov
Raze Site Fill Site Excavation Site
Construction Site
Acres
Same as Applicant