Resource Management
Boone County, Missouri
801 East Walnut, Rm. 315
Columbia, MO 65201-7730
573-886-4330
Stormwater Discharge Permit Application
Stormwater Discharge Permits are required for any land development that will discharge in to a municipal separate
storm sewer system (MS4) or other publicly-owned storm sewer system. The applicant can request a Stormwater
discharge permit through the Boone County Resource Management Office. N
OTE
:
When properly validated, this form
constitutes a permit.
Please attach additional sheets as required to fulfill application requirements. NO
CONSTRUCTION INSPECTIONS MAY TAKE PLACE UNTIL THE STORMWATER DISCHARGE PERMIT
HAS BEEN ISSUED.
J
OB
/S
ITE
I
NFORMATION
OWNER: _________________________________________________________________
Name Address Phone
_______________________________________________________________________
Fax Number Email Address Mobile Phone
PROJECT NAME:_________________________________________________________________
PROJECT DESCRIPTION:______________________________________________________
PROJECT ADDRESS: _________________________________________________________
SIZE OF DEVELOPMENT: ____________ PARCEL #__________________________________
DEVELOPER: _______________________________________________________________
Name Address Phone
_____________________________________________________________________
Fax Number Email Address Mobile Phone
CONTRACTOR______________________________________________________________
Name Address Phone
_____________________________________________________________________
Fax Number Email Address Mobile Phone
OWNER SIGNATURE:_____________________________________________________________
F
OR OFFICE USE ONLY
Permit fee: $___________ Receipt #:_______________ Date Paid:___________
Construction plan/Erosion & Sediment Plan approval date:_____________________
Construction Start date: ____________________
Permission is hereby given to proceed with construction as shown on the approved plans and in compliance with the
Ordinances of Boone County:
Signature of Approving Authority Date:
For office use only
Permit number:______________
Date Received:______________
Related permits:_____________
Issue date:__________________
click to sign
signature
click to edit
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