* As Defined by 327 IAC 15-5-4, the Person Required to Submit the NOI Letter and Who Is

Allen County
Application for Stormwater Management Plan Permit
Allen County Surveyor’s Office 200 East Berry Street, Suite 350
Fort Wayne, Indiana 46802 / Phone Number: (260) 449-7625
FAX Number: (260) 449-7627


Project Name:
Project Location Description:
Hydrologic Unit Code: / Receiving Water/Point of Discharge:
Plan Submittal Date: / Civil Township:
Quarter: / Section: / Township: / Range:
Latitude and Longitude: / Total Project Acreage:
Acreage to be Disturbed: / Number of Lots: / Parcel Number:
Project Site Owner *:
Contact Name:
Address:
City: / State: / Zip:
Phone: / FAX:
E-Mail:
Plan Preparer Name:
Company Name:
Address:
City: / State: / Zip:
Phone: / FAX:
E-Mail:
Contractor/Builder Contact: / Phone:
Site Erosion Control Supervisor: / Phone:
Cell Phone: / FAX: / Email:
Address:
Permit Application Check-In Checklist (place an “X” next to each item submitted)
2 Copies of Construction Plans including Plat and Legal Description:
Copy of Stormwater Pollution Prevention Plan for Construction Sites:
Copy of Post-Construction Stormwater Pollution Prevention Plan, with calculations if applicable:
Copy of Allen County Application for Stormwater Management Plan Permit (this form):
Copy of Stormwater Drainage Technical Report/Watershed Maps:
Copy of Completed Draft Notice of Intent (NOI), State Form #47487:
Copy of Project Site Owner Statement of Financial Responsibility Form:
Copy of Post Construction Operations and Maintenance Manual:
Copy of Proof of Publication of Notice of Intent in Local Newspaper
Copy of Recorded Maintenance Agreement:
Digital Copy that contains everything (optional):
Permit Application Fees– include Review Fee, Application Fee, Erosion Control & Post Construction Inspection Fees
Check(s) attached with applicable fees paid:

* as defined by 327 IAC 15-5-4, the person required to submit the NOI letter and who is responsible for the permitted project plans being implemented according to plan; normally a developer or person who has financial and operational control of construction activities and project plans and specifications.

Signature of Project Site Owner*:______Date: ______

Stormwater OrdinanceApplication for Stormwater Management Plan Permit - Page 1 of 1 Revised: October 2, 2014

Technical Standards