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Revised Nov 2011, by MJA. Department of Utilities Stormwater Division (303) 655-2121 [EMAIL REDACTED] ESC Permit is required for all land disturbance activities equal to or greater than one acre, OR for land disturbance activities less than one acre that are part of a larger common development. A. Project Information: Building Grading Right-of-Way Project/Subdivision Name: Address/Location: Filing/Block/Lot: (list all lots covered under this permit) *additional space on the back of application Site Area: (total acres that will or may be disturbed) Estimated time to project build out: Project Description: Colorado State Stormwater Permit # COR-03: Certification Pending (attach copy of State Application) Signed Agreement with permit holder B. Financial Security Information (required for grading, right of way or temp use projects only) Estimated cost of Best Management Practices: (incurred to manage erosion/stormwater & re-establish vegetation) $ Bond amount accepted Required Bond amount: Bond Reference Note: An itemized list and estimated cost of Erosion Control BMPs must be included in the General Bond, otherwise a separate ESC Bond will be required. For BMPs cost estimate information visit www.brightonco.gov C. Contact Information: Construction Site Operator: (responsible party for site compliance) Construction Company Name: Operator Name & Title: Address: Phone: Fax: Mobile: E-Mail: Land Owner: Company Name: Land Owner Name & Title: Address: Phone: Fax: Mobile: E-Mail: Other Local Contact: Company Name: Name & Title: Address: Phone: Fax: Mobile: E-Mail: I certify under penalty of law that the ESC Permit application was prepared to the best of my knowledge & believe is true, accurate & complete D. Applicant ***For Office Use Only*** Acknowledgement Certificate Signed: Yes No ESC Permit Application Received by: ESC Plan or Stormwater Management Plan (SWMP) Yes No ESC Permit Issuance by: Copy of the State Stormwater Permit (COR-03) Yes No ESC Permit Fee: Receipt Staff Comments: ESC Permit expiration Date: 1 (one) year after date of issuance ESC Permit Erosion and Sediment Control (ESC) Permit Application ---PAGE BREAK--- Revised Nov 2011, by MJA. ESC Permit Submittal Requirements Erosion and Sediment Control (ESC) Permits are required for all projects disturbing one or more acres of land, or for smaller projects that belong to a common plan of development larger than one or more acres. Failure to provide the following required information will result in a delay in Building, Grading, Temporary Use or Right-of-Way Permit issuance. A copy of the approved ESC Permit must be submitted with every Building, Grading, Temp. Use and ROW Permit Application. It is the City’s intent to remain expeditious in processing the ESC Permit. Therefore, we request that you come prepared with all required information when submitting your ESC Permit application. Please allow five business days for the ESC Permit application review process ESC Permit submittals shall include: 1) ESC Permit Application: a) Project Information: Project/Subdivision name, Project address, list of lots, land area (in acres) that will or may be disturbed during grading or construction, project description, estimated date for completion of project build-out and Colorado State Stormwater Permit number. b) Financial Security Information: required for grading, right-of-way or temp. use projects only. c) Contact Information: Contact information for the person responsible for overall stormwater & erosion control compliance, land owner and other local contacts. d) Signature: applicant’s signature and date. 2) ESC Plan (also known as Stormwater Management Plan -SWMP) and Erosion Control civil plan: The ESCP/SWMP must, at a minimum, meet the requirements prescribed by the Colorado Department of Public Health and Environment. For additional guidance visit: www.brightonco.gov and www.cdphe.state.co.us 3) Copy of the Certification Number of State Issued Stormwater Permit for Construction Activity: Note: The State requires that all applicable land disturbing projects apply for a Stormwater Permit at least ten (10) days prior to commencement of work. a) If certification has not been received from the State prior to application for an ESC permit, the applicant may provide a copy of the completed State Permit Application form along with the date it was submitted to the State. b) If your Company will be covered under the Developer’s State Stormwater permit, then a written and signed Agreement between both companies needs to be submitted in addition to the Developer’s ESCP/SWMP. The agreement must address ESC permit requirements and responsibilities. 4) Acknowledgement Certificate: By signing the form, that applicant acknowledges that he/she had read and understands the City of Brighton Stormwater Quality Enforcement Policy (refer to acknowledgement form and policy posted on the website). 5) Financial Security for Grading/Right-of-Way/Temporary Use projects: Developers are required to provide financial security in a form and language acceptable to the City. 6) ESC Permit Fee for all types of projects: 50 dollars and 50cents. For more information please contact Juliana Archuleta at (303) 655-2121, e-mail [EMAIL REDACTED] or visit www.brightonco.gov and navigate to Utilities Department - Construction Site Stormwater Management page. Filing/Block/Lot: *additional space to list all lots covered under this permit