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�.ITS` �jf L��C��I;tE <br /> Page 1 of 3 <br /> LECLAIRE COSESCO ���'���Yf��'�'' si„�,� <br /> �: <br /> (CONSTRUCTION SITE EROSION AND SEDIMENT CONTROLp�� , �� '�ICATION) <br /> -GL� ...�t .�t� <br /> CITY OF LECLAIRE,IOWA � <br /> 325 WISCONSIN STREET <br /> LECLAIRE,IOWA 52753 <br /> PHONE: (563)-289-4242(Ext. 1004) <br /> FAX: (563)-289-6014 , <br /> E-MAIL: echoate(�u leclaireiowa.Eov PERMIT#: 3pl'�5a <br /> , CITY INITIALS: �__ ��� <br /> TOTAL PERMIT FEE: VAR[ANCE/SPECIAL EXCEPT? � <br /> (YES) (1 O <br /> (TYPE OR PRINT IN BLACK INK ONLY) <br /> ADDRESS OR LEGAL DESCRIPTION OF PROPOSED CONSTRUCTION SITE: Out Lot A—Pebble Creek N 8th <br /> Addition Forest Grove Drive and 35`h Street LeClaire IA,52753 <br /> DESCRIPTION OF WORK TO BE COMPLETED: The general scope of work will be temporarv stock pilin�of dirt due to <br /> di�eine of residential homes foundations.Out Lot A—Pebble Creek North 8th Addition to the City of LeClaire <br /> ESTIMATED START DATE: - ` �'' ' r �I2j' ESTIMATED COMPLETION DATE: 1 '^ ' "' �I�" <br /> RESPONSIBLE PARTY**: Rockne Brosman/Evercore Holdin lowa LLC PHONE#: 832-426-4289 <br /> Z�� S-F <br /> MAILING ADDRESS:�Kirby Dr Houston TX,77019 24 HR.EMERG.CONTACT#: 309-269-2023 <br /> EMAIL ADDRESS:_rbrosman(a�Evercorecompanies.com OTHER INFO.: <br /> ** (As defined in Section 162A1 of the LeClaire Municipal Code—Ord.#672,(see attached)as amended.) <br /> (!F D/FFERENT FROM ABOVE) <br /> PROPERTY OWNER: Evercore Holding Iowa LLC MAILING ADDRESS: �32Z�Cirbv Dr Houston TX,77019_ <br /> PHONE#: 832-426-4289 EMERG.CONTACT#: 309-269-2023 <br /> PRIME CONTRACTOR: Construction Equit LLC MAILING ADDRESS: 2727 Kirby Dr Houston TX,77019 <br /> PHONE#: 832-426-4289 24 HR.EMERG.CONTACT#: 309-269-2023 FAX#: <br /> APPLICATION SUBMITTAL REVIEW&CHECK LIST: <br /> YES 1. If applicable,has an IDNR NPDES General Permit#2 authorization been issued for this site? If so,attach all <br /> supporting documentation,including permit#. <br /> _YES_ 2. Have you attached a copy of the approved Stormwater Pollution Prevention Plan(SWPPP),including the executed <br /> certification statement included therein? <br /> YES 3. Have you attached a copy of the approved grading plans? <br /> 4. Have you attached a copy of the Performance&Maintenance Bond(s)as required? <br /> � 5. Have you attached an executed copy of the City's standard"Hold-Harmless and Waiver of Liability"form(see <br /> attached form)and certificate of insurance as required? <br /> APPLICATION SUBMITTAL REVIEW&CHECK LIST: (cont.) <br /> PPLICATION.doc <br /> ����{� <br /> NORTHLAND�SECURITIES <br /> �o -a-/� <br /> www.northlandsecurities.com <br /> Home Office 800-851-2920 �.�.��� /���� <br /> Iowa Office 641-750-5720 <br /> �5�5� �� - <br /> � � i�l'T���s w� <br /> �. ,�- � . <br /> �� �� <br /> � �=�����`� ./���/� �� . <br /> - � �r �,. � .. <br /> � ��_ � • <br /> w �.� - ,��,�:� <br />