Fillable PROJECT INFORMATION Prior to commencing construction activities that (Clayton, North Carolina)

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PROJECT INFORMATION Prior to commencing construction activities that (Clayton, North Carolina)

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November 2020 Page 1 of 1
STORMWATER PERMIT APPLICATION
Prior to commencing construction activities that propose to increase the impervious area on a property as
outlined by Chapter 158 of the Town’s Land Usage Ordinance within the Town of Clayton, a stormwater permit
must be obtained. Permit fee due upon permit issuance.
PROJECT INFORMATION
Name of Project:
Project Number:
Project Location:
DEVELOPER INFORMATION
Developer/Owner:
Mailing Address:
REQUIRED INFORMATION FOR STORMWATER PERMIT APPROVAL
Approved Site/Subdivision Construction Drawings, 2 sets
Stormwater Density: High or Low
% of BUA:
# dwelling units/acre:
Number of Discharge Points:
Number of SCMs: Primary Secondary
Nitrogen Loading Requirement utilized:
Runoff Treatment Runoff Volume Match
Maintenance Covenant, recorded
Performance Securities (SCM construction cost, plus 25%)
Nutrient Offset fee receipt, if applicable
Stormwater Permit Fee
I HE
REBY CERTIFY that the above information is correct to the best of my knowledge and the
Stormwater plan will conform to applicable ordinances. I further agree to indemnify and hold harmless
the Town of Clayton from any liability damages or losses resulting directly or indirectly from the
construction activities described hereon. I acknowledge that violation of stormwater regulations may
result in civil penalties.
App
licant’s Name (print) Signature Date Phone #
TOWN OF CLAYTON
Engineering & Inspections Department
111 E. Second Street, Clayton, NC 27520
P.O. Box 879, Clayton, NC 27528
Phone: 919-553-5002
Fax: 919-553-1720
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PROJECT INFORMATION Prior to commencing construction activities that (Clayton, North Carolina)

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Completed 22 January 2021

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