MDE e-Permits

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Notice of Intent for Stormwater Associated with Construction Activity

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Signatory Authority

Applications for a State Discharge Permit must be signed by a responsible official in accordance with COMAR 26.08.04.01-1B(5): for a proprietorship, by the proprietor; for partnerships, by a general partner; for corporations, by the principal executive officer, or authorized representative; for municipal, state, or other public facility; by principal executive officer, ranking elected official, or other authorized employee. If the facility is owned by one party and leased to another, please identify both parties and have the appropriate representatives of both parties sign this application. Attach additional sheets as needed. If the facility is owned by a business entity, please identify the resident agent and principal executive officer, with their complete addresses, on this application.

Notice

18 U.S.C. Section 1001 provides that:
Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals, or covers up by any trick, scheme, or device a material fact, or makes any false, fictitious, or fraudulent statements or representations; or makes or uses any false writing or document knowing same to contain any false, fictitious, or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than 5 years, or both.

Privacy Act Notice

This notice is provided pursuant to the Federal Privacy Act of 1974, U.S.C Section 552a. Disclosure of your organization's Federal Tax Identification number with this application is mandatory pursuant to the Maryland Environment Article, Section 1-203 (2003), which requires MDE to verify that applicants for the renewal of permits or licenses have paid all undisputed taxes and unemployment insurance. This information will not be used for any purposes other than those described in this Notice.

Certification Statement

This Application must be certified by the Signatory or a preparer for the Signatory as authorized through an MDE e-Permits subscriber agreement submitted to MDE and accepted by MDE for use in this system. The e-Permits subscriber agreement may be submitted to MDE after the NOI, but the lack of a valid subscriber agreement may delay permit coverage. The e-Permits subscriber agreement is available on MDE’s webpage at: https://mde.maryland.gov/programs/water/wwp/Pages/gp_construction.aspx.

I certify and affirm under penalty of law that this document was completed under my supervision and that the information contained herein is accurate and truthful to the best of my knowledge. I further certify that the information concerning ownership/control of this site/project is accurate. I am responsible for the construction activities of this site/project, for satisfying the requirements of this discharge permit, and for any civil or criminal penalties incurred due to violations of this permit as set forth in Maryland and/or federal laws and regulations. I am aware that submitting false, inaccurate or incomplete information may result in the denial or revocation of the permit, or be subject to any other sanctions allowed under Maryland Law.

Specify who you are.

I am the Signatory named on this Notice

I am a preparer authorized by the Signatory

By signing my name below, I certify the statement above.

Name:

An email will be sent to the Signatory's email address shown below and request that they log into the MDE e-Permits system to finish certifying this Notice.

Email:

felix@email.com

Preparer’s Information

First Name:

Last Name:

Organization: (if applicable)

Phone:

Email:

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