| Applicants Name: |
_____________________________
|
Date:____________
|
| Mailing Address: |
_____________________________
_____________________________
_____________________________ |
Phone:__________ |
Site Location:________________________________________________________________
Area of Total Tract:_________________________Sq.Ft.
_______________________Acres
Carefully study the Storm Water Management: Erosion and Sedimentation
Control (section 618 A-K) of the Subdivision and Land Development Ordinance
(No.198) adopted in 1989, then complete the following:
| (1) |
Area of total tract with impervious surfacing: |
__________Sq. Ft. |
| (2) |
Percentage of impervious surfacing to total tract area: |
____________% |
| (3) |
Area of tract subjected to earth disturbance: |
__________Sq. Ft. |
| (4) |
Percentage of area being disturbed to total tract area: |
____________% |
| (5) |
Number of trees on tract |
____________ |
| (6) |
Number of trees in area subject to EARTH DISTURBANCE
ACTIVITY: |
____________ |
| (7) |
Percentage of trees in area subject to EARTH DISTURBANCE
ACTIVITY
to total number of TREES of tract: |
____________% |
| (8) |
Is any portion of tract within Floodplain Conservation
District? |
Yes_____No____ |
| (9) |
Is any portion of EARTH DISTURBANCE ACTIVITY within
Floodplain Conservation District? |
Yes_____No____ |
| (10) |
Does EARTH DISTURBANCE ACTIVITY create a steep slope? |
Yes_____No____ |
| (11) |
Describe soil Types/Slope per Chester Co.
- Delaware Co. Soil Survey Designations: ______________ |
| |
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
|
| (12) |
Does EARTH DISTURBANCE ACTIVITY cause any disturbing;
modifying; flocking; diverting; or offsetting of the naturaloverland
or subsurface flow of water on the township? |
Yes_____No____ |
If the answer to any of the following is "Yes"
- present a Storm Water Management Permit in accordance with the Storm
Water Management, Erosion and Sedimentation Control section of the Subdivision
and Land Development Ordinance No. 198
| I. |
If the answer to (2) is greater than 70%; its the
answer to (3) greater than 400 Sq. Ft.? |
Yes_____No____ |
| II. |
If the answer to (3) is less than 70%; is the answer
to (4) greater than 20% or the answer to (3) is greater than 7500
Sq. Ft.? |
Yes_____No____ |
| III. |
Is the answer to (7) greater than 10%? |
Yes_____No____ |
| IV. |
Is the answer yes to (8), (9), (10), (11) or (12)?
|
Yes_____No____ |
Permit Application Prepared by:
Name: ______________________________________________
Address: ____________________________________________
Phone: ______________________________________________
Application Affidavit: The plans, reports, and documents submitted as
part of this Permit Application are true and
correct to the best of my knowledge and belief.
________________________________________________
Signature of Applicant
-------------------------------------------------------FOR OFFICE USE
ONLY -------------------------------------------------------
Permit is hereby granted to the above named
applicant to implement the plans referenced herein with full accordance
with the terms and conditions of Section 618 of No.198 of the Township
of Upper Providence, Delaware County, Pennsylvania.
Date Received: _________________________ Fee: _________________ Escrow:
____________________
Plan Title: ___________________________________________________
Prepared by: _________________________________________________
Date: _______________________________________________________
File #: ______________________________________________________
Shts: ___________________ of Shts: _____________________________
Surety:
__________________________________________________
Township Engineer/Date
|