Charter Township of Orion Building Department
2525 Joslyn Rd., Lake Orion, MI 48360
Phone (248) 391-0304, ext. 6000
[email protected]
Permit Application for Part 91
Sedimentation Control
RESIDENTIAL
1. APPLICANT
Name
Landowner
Designated Agent
Address
City
State
Zip Code
Telephone Number
Email
2. LOCATION
Address
City
Subdivision
Lot No.
3. PROPOSED EARTH CHANGE
County
Project Type:
Residential
Multi-Family
Size of Earth Change (acres/square feet)
Describe Project
Name of and Distance to Nearest Lake, Stream, or Drain
Tax ID Number
Date Project to Start
Date Project to be Completed
4. SOIL EROSION AND SEDIMENTATION CONTROL PLAN (Refer to Rule 323.1703)
NOTE: Include two (2) plot plans with application
Estimated Cost of Erosion and Sediment Control $____________
5. PARTIES RESPONSIBLE FOR EARTH CHANGE
Name of Landowner (if not provided in Box No. 1 above)
City
State
Address
Zip Code
Telephone Number
I (we) affirm that the above information is accurate and that I (we) will conduct the above described earth change in
accordance with Part 91, Soil Erosion and Sedimentation Control, of the Natural Resources and Environmental Protection Act,
1994 PA 451, as amended, applicable local ordinances, and the documents accompanying this application.
Landowner's Signature
Print Name
Date
Designated Agent's Signature*
Print Name
Date
*Designated agent must have a written statement from landowner authorizing him/her
to secure a permit in the landowner's name.
OFFICE USE ONLY
Permit Number_________________ Date Issued______________ Expiration Date________________
Inspector_______________________________Approved_________ Denied________ Date_________
Permit Application Sedimentation Control Residential 4.20.2017
The following is required to be submitted with the completed application:
Site plan showing the following:
1) Map with scale: 1" = 200' or less, or indication of exact distances between
noted features on site plan
2) Legal description of property (town, range, section, quarter-quarter section)
3) Proximity of any proposed earth change to lakes and/or streams
4) Predominant land features
5) Slope description or contour intervals
6) Soils survey or written description of the soil types of the proposed exposed land area
7) Description and location of the physical limits of each proposed earth change
8) Description and location of all existing and proposed on-site drainage and
dewatering facilities
9) Timing and sequence of each proposed earth change
10) Location and description for installing and removing all temporary SESC measures
11) Description and location of all proposed permanent SESC measures
12) Maintenance program for all permanent SESC measures and designation of person
responsible for maintenance
Answer "Yes" or "No" to the following questions
Will a septic field be installed?
Will a basement be excavated?
Will excavation be limited to 42" deep footings?
Will any material be removed from the site?
Will any "fill" material be brought onto the site?
Will excavated material be used for backfilling around house only?
Will the entire lot be graded?
Annual on-site review and inspections escrow fee
If the total development lot, parcel, or site acreage is:
Less than 1 Acre and at least 100 feet from wetlands as defined in Ord. 139
Less than 1 Acre and within 100 feet of a wetlands as defined in Ord. 139
More than 1 Acre and at least 100 feet from wetlands defined in Ord. 139
Plus $50.00 for each added acre or portion there of.
More than 1 Acre and within 100 fee of a wetlands as defined in Ord. 139
Plus $50.00 for each added acre or portion there of.
$200.00
$400.00
$200.00+
$400.00
TOTAL Acreage:__________________ Total Escrow Fee: $___________________
Return balance on inspection escrow to:
Property Owner
Designated Agent*
* Letter of Authorization from Property Owner must be submitted to return escrow balance to Designated Agent
Permit Fee: $100.00
Inspection Schedule Fees
Initial Inspection - No Charge
Regular Scheduled Inspections - $40.00 (every 30-60 days until site is stabilized with permanent
vegetation.
Permit Expiration
Permit will expire one (1) year from date of issue. Projects not completed or substantially underway
within that year may be renewed for additional year, for an additional annual on-site review and
inspection fee, as calculated above, and permit fee.
Soil erosion and sedimentation control measures must be implemented and inspected prior to beginning any
project. Contact Tim London at 248-391-0304 ext. 6007 to schedule your initial inspection.
Soil Erosion and Sedimentation Control Application 3.9.2017
Charter Township of Orion Building Department
2525 Joslyn Rd., Lake Orion, MI 48360
Phone (248) 391-0304 ext. 6000
[email protected]
Letter of Authorization
Effective immediately, Part 91 requires each designated agent applying for a Soil
Erosion Permit on behalf of another person to include a statement authorizing him/her
to secure the permit. Please have the landowner complete this Letter of Authorization
to be submitted with the application.
___________________________is authorized to secure a Soil Erosion Permit in my name for a
(Name of Designated Agent)
project requiring said permit at: ________________________________________________________
(Address of Project Location)
_______________________________
(Print Name of Landowner)
_______________________________
(Signature of Landowner)
_______________________________
(Date)
Soil Erosion Letter of Authorization 3.2.2017