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ResidenƟal LDP Dawson County Community Development Department 25 JusƟce Way, Suite 2322 Dawsonville, GA 30534 Check List o Copy of Approved Stamped ES&PC Plans from in Athens. They require 3 copies for review. 4310 Lexington Rd. Athens, GA 30605 o Copy of receipt for payment of State NPDES fees. o Copy of NoƟce of Intent (NOI) filed with the State Environmental ProtecƟon Division (EPD); (filing with the State is an all-electronic process; print a copy of the NOI form for inclusion in your applicaƟon for land disturbance permit). o Copy of current Level 1A Fundamentals cerƟficaƟon (Blue Card) or higher - Copy of cerƟficaƟon shall be for the person conducƟng grading operaƟons for this project. o Completed applicaƟon o Dawson County LDP Fees ---PAGE BREAK--- ResidenƟal LDP Dawson County Community Development Department 25 JusƟce Way, Suite 2322 Dawsonville, GA 30534 Project Name: Proposed Use of Land: Total Acreage: Disturbed Acreage: Site Address/LocaƟon: Tax Map/Parcel Number: Property Owner: Property Owner Address: Phone Number: Developer: CerƟficaƟon Number: 24 Hour Emergency Contact for Soil Erosion Issues: Name: Phone: Email: ApplicaƟon is hereby made according to the Land Use ResoluƟon of Dawson County, Georgia, the Subdivision RegulaƟons of Dawson County, Georgia, the Storm Water Management Ordinance of Dawson County, Georgia and applicable laws and regulaƟons, including, but not limited to, the Soil and SedimentaƟon Control Ordinance of Dawson County, Georgia. I agree to comply fully with all requirements of above reference laws and regulaƟons. I understand that these documents are available for my review and that infracƟons may cause immediate revocaƟon of this permit and the stoppage of all work. Applicant Signature: Date: Staff’s Signature: Date: