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

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I hereby request consideration for a Maintenance Credit and further authorize the City of Delaware to inspectthe above identified stormwater facility(ies) for the purposes of assessment for possible stormwater servicefee credit. I certify that I have authority to make such a request and authorization for this property. I furthercertify that the above information is true and correct to the best of my knowledge and belief. I agree tomaintain the above stated ditch to the prescribed criteria stated in the Credit Application Manual andaccording to the maintenance plan attached. I hereby release the City of Delaware from any maintenanceresponsibility whatsoever on the above identified channel(s) located on my property. I agree to providecorrected information should there be any change in the information provided herein._____________Type or print nameTitle or AuthoritySignature________________________________Date
CITY OF DELAWAREIMPERVIOUS SURFACE AREA EVALUATIONAPPLICATION FORMInstructions:1. Fill out this form completely. A separate application must be made for each separate propertylocation. One application can be made for multiple stormwater detention/retention facilities to beinspected on the same property. Attach a separate sheet giving parcel location, description andnumber(s) for each parcel for which you are requesting evaluation.2. Enclose a certified check or money order made out to City of Delaware for two hundred fifty dollars($250.00) per location (Fee to be refunded if adjustment of over 10% is made in the property owner’sfavor).3. Fill out and attach a Right-of-entry Form (Form 3).4. Mail the completed form, payment and Right-of-entry to: Utilities Director, One South SanduskyStreet, Delaware Ohio 43015.Site Location/:Development Name________________________________________________________________Street AddressOH_____________________________City State ZipWater/Sewer/Stormwater Billing Account Number: _________________________________________Authorized Contact:_________________________________________________________________Name & Title (last, first and title)Contact MailingAddress:_________________________________________________________________Street AddressOH______________________________City State Zip PhoneClosest Cross Street:Side of Street (North, etc.):Distance and Direction from Cross Street:Landmark(s):Facility Location on Site (attach separate sheet for each facility giving location and description):Description of Facility(type of use)I hereby request consideration for a Minimum Peak Flow Credit and further authorize the City of Delaware ortheir authorized representative to inspect the above-identified property for the purpose of investigation for astormwater service fee adjustment. I certify that I have authority to make such a request and authorizationfor this property.Type or print nameSignature__________________________________________________Title or Authority________________________________________Date
Page 2 and 3: Refer to the City of Delaware Erosi
Page 4 and 5: Where: C is the Rational Method C f
Page 6 and 7: STEP 2:STEP 3:The owner insures the
Page 8 and 9: credits received cannot exceed 100%
Page 10 and 11: Instructions:1. Fill out this form
Page 12 and 13: STORMWATER FACILITY CALCULATIONS AN
Page 14 and 15: CITY OF DELAWAREForm 3 - Right of E

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