city of delaware department of public utilities division of stormwater ...

CITY OF DELAWAREForm 4 - Open Channel Maintenance Credit Application FormInstructions:1. Fill out this form completely. A separate application must be made for each separate propertylocation. One application can be made for multiple public stormwater open channels on the sameproperty. Insure channel(s) are properly maintained.2. Attach a separate site plan showing open channel location, and attach evidence of tributary area,and proof that the ditch or channel is a public stormwater open channel for each separate ditchlocation on the same property for which you are requesting credit.3. Attach evidence of an easement dedicated to the City for each ditch for which you are requestingcredit.4. Mail the completed form and Right-of-Entry to: Utilities Director, City of Delaware, One SouthSandusky Street, Delaware, Ohio 43015.Site Location:________________________________________________________________Street AddressOH____________________________City State ZipAuthorized Contact:Contact MailingAddress:________________________________________________________________Name & Title (last, first and title)_______________________________________________________________Street Address_______________________________________________________________City State Zip Phone/FaxCHANNEL INFORMATION SECTIONNote: Attach separate information as necessary for each separate channel located on the property.Total number of channels for which I am requesting creditOpen Channel ID #: ____ ______Location on Site: ________________________________________________________________Length of Open Channel:ft.Please attach: 1. A site plan of the site locating the channel.2. Evidence of the tributary area of the channel.3. Evidence that the ditch is a public stormwater open channel.