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Please mail or drop off the completed/signed form and original bond to the Columbia County Stormwater Compliance Department. Mail: P.O. Box 498, Evans, GA 30809 ♦ Street: 630 Ronald Reagan Drive, Bldg. A, East Wing, Evans, GA 30809 Questions? Call: (706)447-7645[SOIL] / Email: [EMAIL REDACTED] Page 1 of 2 Revised 3/2021 Environmental Bond Administrative Form PROJECT NAME (Phase): PARCEL ID: COMPANY BOND ISSUED TO (*Note: This must match the Notice of Intent and/or Land Disturbance Permit Application*): GA Secretary of State Control Number: Last Annual Registration Year: BONDED COMPANY CONTACT INFORMATION: Name: Address: Phone Number: Email Address: BANK OR BONDING COMPANY NAME: BOND ISSUING AGENT CONTACT INFORMATION: Name: Address: Phone Number: Email Address: SURETIES: All applicable sureties are required prior to the issuance of a Land Disturbance Permit by the Columbia County Stormwater Compliance Department. EROSION CONTROL (Disturbed acreage rounded to nearest 1/10th Acre) $3,000.00/ACRE x ACRE(S) = $ County Code - Soil Erosion, Sedimentation, and Pollution Control Ordinance, Section 34-70, The County may require the permit applicant to post a bond in the form of government security, cash, irrevocable letter of credit, or any combination thereof up to, but not exceeding, $3,000.00 per acre or fraction thereof of the proposed land-disturbing activity, prior to issuing the permit. If the applicant does not comply with this article or with the conditions of the permit after issuance, or the bond, the county may call the bond or any part thereof to be forfeited and may use the proceeds to hire a contractor to stabilize the site of the land-disturbing activity and bring it into compliance. This bond shall not be required in the event a performance and maintenance bond, as set forth in Sec 74-45, has been provided to the county for the same improvements and for conditions of the Land Disturbance Permit and the Notice of Termination. SURETY AMOUNT = $ BOND ISSUE DATE: BOND EXPIRATION DATE: ADDITIONAL INFORMATION OR COMMENTS: OWNER CERTIFICATION AND SIGNATURE: I hereby certify that this surety will be released upon approval of final stabilization from Columbia County Stormwater Compliance Department. Property Owner or Owner’s Authorized Representative (Print) Property Owner or Owner’s Authorized Representative (Signature) Date SIGN ---PAGE BREAK--- Please mail or drop off the completed/signed form and original bond to the Columbia County Stormwater Compliance Department. Mail: P.O. Box 498, Evans, GA 30809 ♦ Street: 630 Ronald Reagan Drive, Bldg. A, East Wing, Evans, GA 30809 Questions? Call: (706)447-7645[SOIL] / Email: [EMAIL REDACTED] Page 2 of 2 Revised 3/2021 OFFICE USE ONLY RECEIVED BY: DATE: SIGNATURE: LDP APP SIGN