LAPORTE COUNTY APPLICATION FOR INDIVIDUAL LOT PLOT PLAN PERMIT REQUEST
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Email *
Project/Subdivision/Minor Plat Name:  *

Lot Number:      

 *

Acreage to be Disturbed:      

 *

Type of Lot or Improvement (Commercial/Residential/Industrial/Other):                        

 *
Civil Township Name:                         
*
Section/Township/Range:

Street Address:      

 *

Property Owner Name:      

 *
Property Owner Phone: *

Property Owner Mailing Address:      

Property Owner e-mail

Plan Preparer Name & Company:      

Plan Preparer 

Mailing Address:      

 *
Plan Preparer Phone:
Plan Preparer E-mail: *

Contractor/Builder:      

Contractor/Builder Contact Person:
Contractor/Builder 

Mailing Address:      

Contractor/Builder Phone:
Contractor/Builder Email:

Individual Lot Operator in Charge of Mandatory Site Stormwater Pollution Prevention:

 *
Individual Lot operator in charge of mandatory site stormwater pollution prevention 

Mailing Address:      

 *
Lot Operator Phone: *
Lot Operator Email
Lot Operator Qualifications per the Construction Stormwater General Permit (CSGP) *
The individual lot operator should be the trained individual in charge of the mandatory site stormwater pollution prevention program who is responsible for installation and maintenance of all erosion and sediment control measures until the site is stabilized.
SIGNATURE:
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DATE: *
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TITLE: *
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