OFFICE USE ONLY

SOIL EROSION & SEDIMENTATION Township

CONTROL PERMIT APPLICATION Permit Number
CALHOUN COUNTY ROAD COMMISSION
Date Issued
13300 15 Mile Road - Marshall, MI 49068
Phone (269) 781-9841 (800) 781-5512 - Fax (269) 781-8223 Expiration Date
www.calhouncrc.net.net Receipt Number

OWNER CONTRACTOR DEVELOPER OTHER

Name: Name:

Address: Address:

City, State, Zip: City, State, Zip:

Phone / Fax: Phone / Fax:

LOCATION
Section Town Range House / Lot No(s) Street Address Crossroads

City/Village Subdivision Township

PROPOSED EARTH CHANGE

Type of change (Project) Size of earth change (Acres)

Distance to nearest lake, stream, drain or waterway affected Start date Completion date

SOIL EROSION & SEDIMENT POLLUTION CONTROL PLAN

(NOTE: Two (2) sets of complete plans must be attached.)
Preparer's Company Name

Plan Preparer's Name Estimated cost of erosion & sediment control

PARTIES RESPONSIBLE FOR EARTH CHANGE (other than applicant/contractor listed above)
Name

Address City State Zip Area Code/Telephone/Fax

Name of individual "On Site" responsible for earth change Company Name

Address City State Zip Area Code/Telephone/Fax

SOIL EROSION AND SEDIMENT CONTROL PERMIT FEES

PLEASE CHECK THE APPROPRIATE CATEGORY:
Residential Earth Change-Up to and incl 2 acres $42.00
1-30 days INCL
31-60 days-ADD $27.60
61-90 days-ADD $55.20
91-120 days-ADD $82.80
121-150 days-ADD $110.40
151-180 days-ADD $138.00
181-210 days-ADD $165.60
211-240 days-ADD $193.20
241-270 days-ADD $220.80
271-300 days-ADD $248.40
301-330 days-ADD $276.00
331-361 days-ADD $303.60
Total Cost- $
Over 2 acres there will be an additional $10.00 fee per acre per 30 days. Acreage will be rounded up to the nearest acre. (i..e. 2.3 will be rounded to 3 and charged an
additional $30.00 per 30 day period)
OTHER EARTH CHANGE-Up to and incl 2 acres $110.40
1-30 days INCL
31-60 days-ADD $165.60
61-90 days-ADD $220.80
91-120 days-ADD $276.00
121-150 days-ADD $331.20
151-180 days-ADD $386.40
181-210 days-ADD $441.60
211-240 days-ADD $496.80
241-270 days-ADD $552.00
271-300 days-ADD $607.20
301-330 days-ADD $662.40
331-361 days-ADD $717.60
Total Cost- $

OTHER EARTH CHANGE- 2 and incl 5 acres $165.60

1-30 days INCL
31-60 days-ADD $276.00
61-90 days-ADD $386.40
91-120 days-ADD $496.80
121-150 days-ADD $607.20
151-180 days-ADD $717.60
181-210 days-ADD $828.00
211-240 days-ADD $938.40
241-270 days-ADD $1,048.80
271-300 days-ADD $1,159.20
301-330 days-ADD $1,269.60
331-361 days-ADD $1,380.00
Total Cost- $

OTHER EARTH CHANGE-5 acres or greater*

Total Cost- $
*Over 5 acres there will be an additional $10.00 fee per acre per 30 days. Acreage will be rounded up to the nearest acre. (i.e. 5.3 will be rounded to 6 and charged an
additional $60.00 per 30 day period)

I (we) affirm that the above information is accurate and that I (we) will conduct the above described earth change in
accordance with Part 91, Soil Erosion and Sedimentation Control, of the Natural Resource and Environmental Protection
Act, Act 451 of the Public Acts of 1994, its corresponding rules, applicable local ordinance and the agreements
accompanying this application. Issuance of this permit does not imply consent for use of the land that may be
inconsistent with other local, township, county, state and/or federal ordinances and does not negate the need for other
such permits. This permit is good for one year from issue date. Applicant will provide a drawing of the site showing
proposed site development.
Owner's Signature Print Name Date

Applicant's Signature Print Name Date

Soil Erosion Permit Application/elc/12/29/08

On the reverse side you will find your Soil Erosion Permit. This permit is being issued under Part 91, of Public Act of 1994 as administered by the
Calhoun County Board of Public Works. This Permit does not prejudice or limit the right of a landowner to institute proceeding in any Circuit Court
of this State against any person when necessary to protect rights.

This permit needs to be posted at or on the job site until the project is completed. If the proposed earth changes are completed ahead of schedule,
please file a written notice of completion so that our office may make a final inspection. In addition, notification must be given to the Permit
Department if the project will extend past the expiration date. If no notification is given, there will be an additional $50.00 fee to extend the permit
after the proposed completion date.

All areas must be protected from erosion and sedimentation in accordance with your approved plan. Please review the conditions listed below with
your construction personnel, as these conditions will be strictly enforced.

1. All earth changes shall be designed, constructed, and completed in the shortest time frame possible.

2. Submission of this application authorizes the CCRC* staff admission to the property for soil erosion inspections.

3. This permit is issued to the property owner who is responsible for the contractor's activities.

4. Thoroughly read the attached Soil Erosion Guidelines and Best Management Principles information packet.

5. Permanent soil erosion control measures for all slopes, channels, ditches or any disturbed land area shall be completed. If significant earth
change activity ceases, temporary soil erosion control measures need to be implemented immediately. All soil erosion and sedimentation
control measures shall be maintained until permanent soil erosion control measures are in place.

6. Sediment needs to be removed from run-off water before it leaves the project site. All necessary precautions shall be employed to retain all
sediment on site. Soil erosion management practices must be applied as needed to prevent erosion / flooding.

7. Any temporary or permanent facility designed and constructed for the conveyance of water around, through or from the earth change area
shall be designed to limit the water flow to a non-erosive velocity.

8. Temporary soil erosion control facilities shall be removed and earth change areas graded and stabilized with permanent soil erosion control
measures pursuant to approved Standards and Specifications.

If you have any questions or concerns regarding this permit, please feel free to contact my office. An appeals process is available for those in dispute
over these permit procedures.

* Calhoun County Road Commission

Soil Erosion Permit Application/elc//12-29-02