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SWM Permit Application (rev. 9/2015) Page 1 of 2 Note: This permit is separate from any permits required by the Montana Department of Environmental Quality. A State Stormwater Construction 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 plan of development or sale that would disturb one acre or more. **No land disturbance is permitted on any project site without an approved City of Kalispell Stormwater Management Permit** **Other permits may be required, e.g. Flood Plain Permit** Contact Information: Project Owner Contact Person: Company: Mail Address: City: State: Zip: Phone: Email: Fax: Mobile: Other: Contractor Contact Person: Company: Mail Address: City: State: Zip: Phone: Email: Fax: Mobile: Other: Engineer Contact Person: Company: Mail Address: City: State: Zip: Phone: Email: Fax: Mobile: Other: Project Information Project Address : Lot Number: Subdivision (if applicable): Project Size: (Land Disturbance) LESS than one acre $10.00 GREATER or equal to one acre $45.00 Nature of Construction Check the appropriate box(es) or provide a brief description that indicates the general nature of the construction activities. Single Family Residential Multi-Family Residential Utility Commercial/Industrial Highway / Road Other (describe): Description of proposed work: City of Kalispell, Montana Stormwater Management Permit Application Permit Number Date Final Stabilization Date Public Works Department 201 1st Ave East Kalispell, Montana 59901 (406) 758-7720 ---PAGE BREAK--- SWM Permit Application (rev. 9/2015) Page 2 of 2 City of Kalispell, Montana Stormwater Management Permit Application Permit Number Date Final Stabilization Date Project Schedule Start Date: Completion Date: Final Stabilization Date: Waterbodies and Storm Conveyance Systems List Waterbodies within 200’ of project Streams: Lakes: Wetlands: Rivers: Sloughs: Other: List Storm Conveyance Systems within 100’ of project Ditches: Swales: Detention Facilities: Storm Drain Inlets: Pipe Inlets/Outlets: Gutter: Acknowledgement Certificate: I certify that I am the Owner or Owner’s authorized agent. If acting as an authorized agent, I further certify that I am authorized to act as the Owners agent regarding the property at the above-referenced address for the purpose of filing applications for decisions, permits or review under the City of Kalispell Ordinance 1600 and have full power and authority to perform on behalf of the Owner all acts required to enable the City to process and review such applications I certify that the information on this application is true and correct and understand that I shall not start this project until this application is approved. I shall comply with the laws of the State of Montana and the ordinances of the City of Kalispell. Signature of Legally Responsible Person (Submission must include original signature) Date Signed Name (printed) Title **For Official Use Only** LESS than one acre Received City By Date SMP Checklist Yes No Field Visit SMP Plan Yes No Approval SMP Map Yes No Comments: Payment-$10.00 Yes No GREATER or equal to one acre Received MT Stormwater Discharge Permit (NOI) Yes No Yes No Site Map showing BMPs Yes No MT Stormwater Discharge Permit (NOT) Yes No SMP Checklist Yes No SMP Plan Yes No SMP Map Yes No Payment-$45.00 Yes No New construction subject to impact fees Yes No SIGN