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PROJECT INFO Project Name Date Property Address Lot Block Subdivision Ground Disturbance Start Date End Date # Acres Disturbed Project Description: APPLICANT INFO Company Name Person Legally Responsible for Permit Compliance Mailing Address Phone # City, State, Zip Fax # Contractor Field Contact Phone # Mobile Phone # TERMS AND CONDITIONS Person Responsible for Compliance Date * By signing below, you agree to comply with all conditions of the Grading and Erosion Control Permit and any applicable sections of the City of Lafayette Municipal Code of Ordinances. Permit not valid until "Grading and Erosion Control Permit" is signed by an authorized agent of the City of Lafayette. By signing, I agree that I have read the terms and conditions listed above and agree to comply: CITY COPY * The applicant shall be required to provide security in the form of cash escrow or an irrevocable letter of credit in the amount of the estimated cost of the work plus 25% for administration/engineering/contingencies. If the Permittee does not successfully complete all required work or violates any requirement of the permit, the City may take corrective action and charge the cost to the Permittee. * A "Stormwater Management Plan" or "Grading and Erosion Control Plan" which complies with the City of Lafayette Standards and Specifications must accompany this application. * A Stormwater Construction Permit or Permit Waiver is required from the Colorado Department of Public Health and Environment for any project disturbing one acre or more. Verification from the applicant that the permit was obtained is required before issue of a permit. * The City may suspend or revoke a Grading and Erosion Control Permit for violation of any part of the applicable sections of the City of Lafayette Municipal Code of Ordinances. * All permanent stormwater quality control measures shall be adequately maintained. Temporary control measures shall be removed after work on the site is complete and the controls are no longer needed. Periodic inspection reports may be required by the City. * Any violation of this permit or of the applicable sections of the City of Lafayette Municipal Code of Ordinances is punishable with a fine of up to $1,000 per offense per day.