MDE e-Permits

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Notice of Intent for Stormwater Associated with Construction Activity

Site Information

Site/Project

Site/Project Name:

Phase: (if applicable)

Site Location

Street: (if applicable)

Location Description: (if no street address is assigned)

City:

County: (select all that apply)

State:

ZIP Code:

If the site covers multiple ZIP codes, choose the ZIP code covering the largest part of the project and enter it here.

Site Coordinates

Provide the latitude and longitude of the discharge point. For projects with more than one discharge point, provide the latitude and longitude of the approximate center of the site.

Latitude: . °

N

Longitude: . °

W

Find latitude and longitude

Site Area

Total Site Area: (acres)

Please note: it is important that you report the Total Disturbed Area accurately below, as your authorization to discharge stormwater will be for this acreage only. This will also affect the fee you are charged, if applicable.

Total Disturbed Area: (acres)

Site Contact Person

The site contact person is the person an inspector should contact at the time of a compliance inspection, such as a construction manager or foreman. It may be the same person as the permit contact person.

Check box if site contact person is the same as permit contact person.

Professional Title:

Specify:

First Name:

Last Name:

Phone:

Email:

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Notice of Intent for Stormwater Associated with Construction Activity

Site Information

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