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Document Unioncountyga_doc_aa8b15400d

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Union County Building Development 46 Hughes Street, Suite A, Blairsville, GA 30512 Phone: [PHONE REDACTED] [EMAIL REDACTED] Fax: [PHONE REDACTED] APPLICATION FOR LAND-DISTURBING ACTIVITY PERMIT Instructions: An application for a permit must include the applicant's Erosion & Sediment Control Plan and must be factual and complete. Upon completion, the Plan must be submitted in triplicate to the above shown address. After approval of the Plan, the fee will be calculated. The applicant can pay the fee and pick up the permit at the above address. Property Mailing Project Name: Location: Tax Parcel: As Project Representative, I certify that I fully understand the provisions of the Union County Erosion and Sediment Control Ordinance, and that I accept responsibility for carrying out the Erosion and Sediment Control Plan for the above referenced project. Project Representative: Phone: Signature: Date: Date received by Issuing Signature: Date received by Technical Signature: Rev. 10/30/17 Fee calcula^on: