Stormwater Management Permit - Woods of Witham Lane - Lot 1 Block 2_Approved3830 PILOT KNOB ROAD | EAGAN, MN 55122-1810
(651) 675-5300 | waterres@cityofeagan.com
For Office Use
Stormwater Management Permit #: ________________
Building Permit #: ________________
Escrow Deposit: ________________
Staff: __________________________
STORMWATER MANAGEMENT PERMIT
Date: ________________ Site Address: __________________________________________________________________________
Description of Project: _________________________________________________________________________________________
Area of Land Being Disturbed: ______________________ Start Date: _____________ Completion Date: _____________
Please submit a Land Disturbance and Stormwater Pollution Prevention Plan with this application.
Property Owner
Name: _______________________________________________ Phone: _______________________
Address / City / Zip: ___________________________________________________________________
Contact: __________________________ Email: _____________________________________________
Applicant is: ____ Owner ____ Contractor
Contractor
Name: ___________________________________________ License #: __________________________
Address: _________________________________________ City: _______________________________
State: _________ Zip: _________________ Phone: _________________________________________
Contact: __________________________ Email: _____________________________________________
Erosion and Sediment Control Performance Security
The City requires an escrow deposit to secure performance of erosion and sediment control (ESC) requirements, including proper
installation and maintenance. The security shall pay for any City costs or expenses to bring the site into compliance with the
stormwater management permit, including any engineering, legal, or administrative expenses; inspections; and necessary work by
City contractor(s). The City may extract from the security escrow. The escrow deposit will be released only upon inspection and
written notice of conformance by the City.
The following escrow deposits include two (2) required City inspections, initial and final.
$1,300/lot
$3,900/lot
$6,500/acre*
Existing Single-Family Residential Lot (addition, demolition, pool, retaining wall, etc.)
New Single-Family Construction
Multi-Family or Commercial Construction (new, addition, demolition)
*Maximum of $15,600
Erosion and Sediment Control Reinspection Fee (for as needed City reinspections after the two (2) included) $115/trip
Security Amount: _______________
The applicant assumes all responsibilities for installation and maintenance of pollution prevention practices on this site.
Any violations of City Code identified by the City shall be addressed within 48-hours of service of the notification.
The applicant understands that failure to maintain pollution prevention practices within the time allotted by the City
notification, will result in enforcement action to correct site deficiencies that are in violation of Sec. 4.34.
The issuance of this permit constitutes a right-of-entry of the City or its contractors to enter upon the construction site for
the purpose of completing ordinance enforcement and/or completing corrective work.
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the
ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and
work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which
requires a review and approval of plans.
The undersigned accepts full responsibility for compliance with the Stormwater Management Ordinance of the City of
Eagan and agrees to comply with the Stormwater Pollution Prevention Plan or equivalent in full.
Performance Security Release
The following information will determine to whom the escrow deposit will be returned. Security will be returned in the form
of a check.
Name:__________________________________________________________________________________________
Address / City / Zip:________________________________________________________________________________
Phone:__________________ Email: __________________________________________________________________
Amount:_________________________ Permit Number: _______________________
FOR OFFICE USE ONLY
SUB TYPE WORK TYPE
Stormwater Management Permit Apartments Commercial/Industrial
Multi Family Public Facility
Single Family
DESCRIPTION
Addition Demolition Pool
New Retaining Wall Other: _________________________________________
REQUIRED INSPECTIONS
Initial Inspection
Final Inspection
SECURITY
Erosion and Sediment Control Deposit (6501.2257)
Other:________________________________
Total:
Reviewed By: ____________________________, Water Resources Date:________________________
x_________________________________________
Applicant's Printed Name
x_______________________________________
Owner's Printed Name
x_________________________________________
Applicant's Signature
x________________________________________
Owner's Signature
______________
Date
______________
Date