TRANSFER OF OWNERSHIP APPLICATION
A. Name of Project: __________________________________________________________________
B. Stormwater Plan Review Approval Date:
C. NPDES Permit Coverage Number (if applicable): SCR10 __________
D. Owner/Developer Name:____________________________________________________________
Addres
s: __________________________________________________________________
City: ___________________________________, State: ___________ Zip: _____________
Phone: _________________ Mobile: _________________ Fax: _________________
Emai
l Address: _____________________________________________________________
E. Property Info: Check Box if same as above
Address: __________________________________________________________________
City: ____________________________________ , South Carolina Zip: _____________
Tax Map Number(s): _________________________________________________________
F. Previous Owner Name: _____________________________________________________________
Addr
ess: __________________________________________________________________
City: ___________________________________, State: ___________ Zip: _____________
Phone: _________________ Mobile: _________________ Fax: _________________
Emai
l Address: _____________________________________________________________
G. Engineer, Technical Representative or Firm: _____________________________________________
Address: __________________________________________________________________
City: ___________________________________, State: ___________ Zip: _____________
Phone: _________________ Mobile: _________________ Fax: _________________
Emai
l Address: _____________________________________________________________
F. Other Information:
a. If there are no modifications being made to the plans, include one (1) set of plans with
signed Designer and Applicant’s certification statements. (This set of plans maybe
submitted on 11x17 as long as it is legible.)
b. If this is a subdivision where a lot or group of lots are being transferred, include a plat
sheet with the lot or group of lots that are being transferred clearly outlined. (This set of
plans maybe submitted on 11x17 as long as it is legible.)
Original Applicant’s Certification
I hereby relinquish the responsibility and ownership of the Town of Summerville Permit listed in Item B
above. I realize that the construction activity responsibility for the identified project/lots/group of lots
now belongs to the new applicant.
______________________________
_____________________________ __________________
Original Applicant’s Printed Name Original Applicant’s Signature Date
New Applicant's Certification
I hereby certify that all construction and/or development will be done pursuant to this plan and I am
responsible for the construction activities and related maintenance thereof. Town of Summerville
authorities will be allowed to enter the project site for the purpose of on-site inspections.
______________________________
_____________________________ __________________
New Applicant’s Printed Name New Applicant’s Signature Date
Town of Summerville, South Carolina Revised April 2015
