Fillable Town of Signal Mountain (Town of Signal Mountain)

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Town of Signal Mountain (Town of Signal Mountain)

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The Town of Signal Mountain (Town of Signal Mountain) form is 2 pages long and contains:

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  • 5 check-boxes
  • 50 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Signal Mountain

BROWSE TOWN OF SIGNAL MOUNTAIN (TN) FORMS

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Town of Signal Mountain
PERMIT
FEES
0 – 2.0 Acres
$25.00
2.1 - 4.9 Acres
$50.00
5.0 – Greater
$100.00
Exception: Residential building additions less than 25% of total building square footage do not require a fee.
LAND DISTURBANCE PERMIT APPLICATION
SI
TE INFORMATION
S
ite Address: ______________________________________________________________________
P
arcel #: _______________________________________________________
Total Parcel Acreage: _________________________________________
---------------------------------------------------------------------------------------------------------------------------------
OWNER INFORMATION
F
irst Name: ___________________________ Initial: _____ Last Name:____________________________
S
treet Address: ______________________________________________________________Apt.: _______
Z
ip Code: _______________ Phone: _______________________ Fax: ____________________________
AP
PLICANT INFORMATION
First Name: ___________________________ Initial: _____ Last Name:____________________________
S
treet Address: ______________________________________________________________Apt.: _______
Z
ip Code: _______________ Phone: _______________________ Fax: ____________________________
1. T
ype of land disturbing planned:
Filling Grading Other _____________________
Stockpiling Excavating
2. On the Sediment & Erosion Control Plan, show the following:
a. P
roposed elevations or contours after land disturbance.
b. Location of access points.
c. Proposed landscaping.
d. Erosion control measures.
e. Flow patterns for surface water before and after the land disturbance.
3. A
drainage plan is required if the area to be disturbed is greater than 1 acre or if you are changing the
vegetative cover.
a. I
s the area to be disturbed greater than 1 acre? __________________________________
b. What is the existing vegetative cover? _________________________________________
c. W
hat is the proposed vegetative cover? ________________________________________
4. Which public roads will you be using to access the site? _____________________________________
5. What are your planned work hours of operation? ___________________________________________
6. How long will you be using this site (duration of land disturbance)? ____________________________
7. Related site address/ parcel ID # ________________________________________________________
8. Square footage Existing Change(+/-) Total
Total parcel area ________sq ft _________sq ft ________sq ft
Footprint of land disturbed ________sq ft _________sq ft ________sq ft
Paved/gravel ________sq ft _________sq ft ________sq ft
Total landscape area ________sq ft _________sq ft ________sq ft
TOTAL IMPERVIOUS AREA = __________________________________
9. The applicant and/ or owner shall be responsible for any road damage or road cleanup as a result of the
land disturbance activity.
APPLICATION IS HEREBY MADE FOR A LAND DISTURBANCE PERMIT TO INTIATE
CONSTRUCTION AS INDICATED ON THE SEDIMENT AND EROSION CONTROL PLAN. SAID
WORK WILL BE DONE UNDER AND IN ACCORDANCE WITH THE ORDINANCES AND
REGULATIONS OF THE TOWN OF SIGNAL MOUNTAIN, SO FAR AS SAID REGULATIONS ARE
APPLICABLE THERTO. THE APPLICANT AGREES TO INSTALL AND MAINTIAN ALL
EROSION CONTROL DEVICES AT THE SITE, IN ACCORDANCE WITH APPROVED PLANS,
BEFORE COMMENCING THE ACTUAL LAND DISTURBANCE, AND UNTIL THE DISTURBED
AREA IS FULLY STABILIZED IN ACCORDANCE WITH THE STORMWATER BMP MANUAL.
THE PERMIT WILL REMAIN VALID FOR TWELVE (12) MONTHS FROM THE DATE OF
ISSUANCE. AT SUCH TIME, THE SITE MUST BE PROPERLY STABILZED OR THE PERMIT
RENEWED.
THE OWNER MUST NOTIFY THE TOWN AT 423-886-2177 AT LEAST 24 HOURS PRIOR TO THE
START OF CONSTRUCTION IN ACCORDANCE WITH APPLICABLE TOWN ORDINANCES AND
POLICIES. THE PERMIT MUST BE KEPT AT THE PROJECT SITE, DISPLAYED AND SHOWN
UPON REQUEST.
I HAVE READ ALL STATEMENTS ON THIS PERMIT UNDERSTAND THEIR MEANING AND
HEREBY AGREE TO ABIDE BY THE PROVISIONS OF THIS PERMIT.
___________________________________________________________ _____________________
Owner/ Owner Agent Signature Date
___________________________________________________________
Print Name and Title
____________________________________________________________ _____________________
Permit Issued By Date
____________________________________________________________ _____________________
Town Manager Date
_____________________
Permit Number
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Town of Signal Mountain (Town of Signal Mountain)

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Completed 4 March 2021

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