Erosion Control Permit Application Permit No.Name First Last PhoneAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code DeveloperPhoneProjected Start Date Date Format: MM slash DD slash YYYY Date of Completion Date Format: MM slash DD slash YYYY Project Location Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Project Description Single Family Plan Unit Development Commercial Industrial Utility Other Pls specifySummarize the land disturbing activities, project phases (if any), brief discription of projectDisturbed Area (Acres/Square Foot)Erosion Control Plan Submitted to Indiana Department of Environmental Management (IDEM) Yes No In Progress Bond Required Yes No Permit Fee Paid Yes No Bond AmountPermit Fee AmountNote: An Erosion Control Plan must be submitted with this application (See Section 8 of City of Martinsville, Erosion Control, Ordinance No. 97-1392 for specifications), even if a plan is not required by IDEM. The erosion control plan must be submitted at least 10 business days prior to issuance of permit to allow City review.
