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LaPorte County Stormwater/MS4 Permit Application
LaPorte County MS4 Director-Nicole Messacar
219-326-6808, ext. 2115 Office
219-344-1492 Mobile
nmessacar@laporteco.in.gov
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* Indicates required question
Email
*
Your email
Project Name
*
Your answer
County
*
LaPorte County
Other-please submit to proper MS4 Authority
Application Submittal Date
*
MM
/
DD
/
YYYY
Hydrologic Unit Code (HUC)
*
Your answer
Project Location Description
*
Your answer
Number of Disturbed Acres associated with project
*
Your answer
Overall Project size (acres)
*
Your answer
Latitude
*
Your answer
Longitude
*
Your answer
Civil Township
*
Your answer
Quarter
Your answer
Section
Your answer
Range
Your answer
Project Owner Name
*
Your answer
Project Owner Phone
*
Your answer
Project Owner Address
*
Your answer
Project Owner E-mail Address
*
Your answer
Qualified Individual Responsible for Inspections Name
*
Your answer
Qualified Individual Phone
*
Your answer
Qualified Individual E-mail Address
*
Your answer
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