2. 
4. Stormwater Exception Application
6. If your project is greater than 1,000 sq ft, please complete the Stormwater Small Project Application instead of this form.
8. Project Street Address*
10. Owner's Name*
12. Signature*
    By entering your name and date above, you are signing this form and agreeing to all terms and conditions of this application.
13. Date*
15. Phone#*
16. Fax#
17. Email Address
19. Person/Firm to be completing work
21. Phone#
22. Fax#
23. Email Address
27. Proposed Activity
29. After April 12, 2004 have you previously added impervious surface on this property?*

    1. Yes
    2. No
31. If yes, Total area of previous impervious surface in square feet
33. Are you removing existing impervious surface as part of this project?*

    1. Yes
    2. No
35. If yes, impervious surface to be removed in square feet
37. Are you adding impervious surface (1,000 square feet or less)?*

    1. Yes
    2. No
39. If yes, total new impervious surface proposed in square feet
41. If yes, type of new impervious surface*

    1. Deck
    2. Driveway
    3. Garage

    1. Shed
    2. Walkway
    3. Other
43. If other please describe
45. Earth DisturbanceActivity
47. Total area of earth disturbance in square feet
49. Type of regulated removal activity (check all that apply)

    1. Excavation
    2. Filling
    3. Grading
    4. Ground Cover
    5. Other
51. If other please describe
53. Check all items below that will be impacted by the project

    1. Downstream property owners
    2. Existing known stormwater problem areas
    3. Floodplain
    4. Known bedrock within 6 feet of the ground surface
    5. Natural water flow paths (creeks, streams, ponds, swales, etc.)
    6. Riparian forest buffer
    7. Slopes greater than 15%
    8. Wetlands
55. Attach a sketch of the proposed additional impervious area or land disturbance
Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit Submit and Print

* indicates a required field