City of Piedmont
Earth Change Application
This application is in cornformance with the provisions of Chapter 18 in the City of Piedmont Code of Ordinances.
Earth Change permits are requred for any project unless exempted by Piedmont Code of Ordinances Section 18-6.
PLEASE NOTE: ALL FEES ARE TO BE PAID BEFORE A PERMIT CAN BE ISSUED. THE CITY OF PIEDMONT’S FEE SCHEDULE CAN BE FOUND ON THE CITY
WEBSITE. FEES ARE SUBJECT TO CHANGE. NO CONSTRUCTION IS TO BEGIN WITHOUT AN AUTHORIZED BUILDING PERMIT.
☐ Residential or ☐ Non-Residential?
Type of Permit (One per application):
☐ Earthwork Permit (minor)
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Project Owner’s Name
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Project Address
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Legal Description of Property (Ex. NW/4, Sec. 32, T14N, R5W)
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Project Mailing Address (If Different)
_____________________________ $_____________________________
Phone Number Estimated Value
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Project Housing Addition (If Applicable)
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Engineer’s Name (if applicable)
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Address
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City, State, Zip Code
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Mailing Address (If Different)
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Phone Number
Please check that the following are included (legible handwritten materials are accepted):
A vicinity sketch of the site for which a permit is required, including a legal description of such property, and boundary line
survey. If platted, a copy of the plat may be submitted.
Site drawings indicating each separate land area to be excavated, filled, graded, or leveled, the finished depth of each separate
land cut or fill, the present and future (as completed) points of entry and discharge for surface water on the subject property,
and identification of all temporary or permanent structures or other devices to be erected or established for the purpose of
controlling or regulating surface water and erosion on such property.
The applicant’s plans for controlling on-site erosion and off-site sedimentation for the purpose of minimizing the deposit of
sediment from the tract under application upon any other off-site public or private property or watercourse during all phases
of project construction.
The applicant’s plans for receipt of surface water on his property and discharge of surface water from his property during
periods of construction and a statement specifying the anticipated time period for completion of all drainage improvements.
The applicant attests that all improves shall meet or exceed International Residential Codes (IRC) and/or International Building Code (IBC) and conform to the Piedmont
Zoning Ordinance, Subdivision Regulations, and all other applicable ordinances. All improvements shall be null and void if the foundation is not completed within six (6)
months or the improvement does not meet or exceed the above requirements or if any application information is incorrect.
Signature: __________________________________________________________________________________ Date: ____________________________________________
Printed Name: _____________________________________________________
