Single-Family Residential Stormwater Credit Application

APPLICANT INFORMATION

Full Mailing Address if different from location address:

Phone Number

CREDIT INFORMATION

Check One:

1.) This is the first credit application for this property.

2.) This is a request for renewal of an existing credit.

3.) This is a reapplication after a credit suspension.

If #2 or #3, has impervious surface been added since the last application/renewal?

Yes

If #2 or #3, has the BMP been modified since the last application/renewal?

Yes

TYPE OF CREDIT

Select one (or more):

Rain garden

On-site stormwater storage

Pervious pavement

Vegetated filter strip

Additional information required for rain garden credit:

Total impervious area (in square feet):

Impervious area draining to garden (in square feet):

Size of garden (in square feet):

Date of construction (month & year):

Additional information required for on-site stormwater storage credit:

Select all that apply:

Rain barrels

Cistern

Number of downspouts draining to storage system:

Volume of on-site storage (in gallons):

Method of draw-down:

Additional information required for pervious pavement credit:

Select all that apply:

Paving blocks

Grid or grass pavers

Pervious concrete or asphalt

Area of installation (in square feet):

Stone reservoir depth (in inches):

Additional information required for vegetated filter strip credit:

Number of downspouts draining to filter strip:

Slope of yard (percent):

Length of filter strip (in feet):

Type of vegetation:

You will need to attach a photo of the BMPs referred to in your application. In addition, we ask that you make a sketch of your property showing the location of the BMPs, take a photo of the sketch and then attach it. An attachment link is at the end of this form.

By signing below, I hereby certify that I own or live at the property and I further declare, under penalty of perjury, that the information provided by me in this application is the truth to the best of my knowledge and belief.

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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

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