DEVELOPMENT PERMIT APPLICATION

trextemperMechanics

Feb 22, 2014 (3 years and 3 months ago)

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DEVELOPMENT

PERMIT APPLICATION

Jefferson
-

Talmo

Planning & Development

706
-
367
-
5011

Serving the
Cities of
Jefferson and

Talmo


**MUST BE FILLED OUT COMPLETELY
AND ALL REQUIRED SUBMITTALS ATTACHED
IN ORDER TO BE PROCESSED**

Property/Site Address:
________
___________________________________
_ City
: ____________________

Subdivision and Lot: _______________________________________________________________________

Tax Map / Parcel: ____________________
_

Zoning: _________ Proposed Use: ___
_______
_____________
_

Total Project Acreage: ___________________ Total Disturbed Acreage: _________________

Sewer
/ _
_
City _
_ County


Se
ptic
(provide copy of permit)



W
ater
/ _
_
City _
_ County


Property Owner

Name: _____________________________
_
_
Phone
: ______________
_

Fax
: ___________

Owner Address: ____________________________________
_ City
: ___________________
_ Zip
: ____
_
___

Email: _____________
_________
_______________


Developer

Name: _
_____
_______________________________
Phone
: _____
_________
_

Fax
: __________

Developer
Address: ____________________________________ City: ____________________ Zip: _______

Developer
Contact Name: _____________________________
_____
___ Contact Number:

_
_______________

Email: _____________
________
________
_______


Project Engineer

Business
Name: __________________________

Phone
: _____________

Fax
: _
__________


Project Engineer

Address: _______________________________
_

City
: ___________________
_ Zip
: _______

Project Engineer

Contact Name: __________________
______________

Contact

Number:

_
_______________

Email: ________
_______
____________________

Soil Erosion
24
-
hour
Contact Name: ___________________________ Contact Number: _________________


Required
Items For Initial
Submittal:



Eleven (11) complete set
s of plans
;



Soil Erosion and Sedimentation Control Permit Application
;

(Attached)

□ Soil Erosion and Sedimentation Control check list;

□ Soil Erosion and Sedimentation Control Educational Contribution

of $40.00 made payable to Oconee River


Soil and
Conservation District.

(See Attached Form)
;


Development Review Fee
S
heet and fee (Note: additional fee requirements are applicable, but not due until


issuance of permit).

(See Attached Form)
;

□ Jackson County E
-
911 Street Name Request Form
;

□ Three
(3) Hydrology Reports
;

□ Copy of N
otice
of

I
ntent filed with the State
;

□ Copy of recei
p
t for payment of State NPDES fees
;

□ Copy of GDOT driveway(s) permit, if required, or completed driveway application;

□ Is the project located in a Historical District?

If so, provide copy of Certificate of Appropriateness.


I hereby make application for a
development
permit

to perform work as described above, and if the permit is granted I agree to
comply with
all

applicable and pertinent
governing
regulations

and ordi
nances
, pertaining to and in accordance with any plans
submitted. I understand failure to comply with these regulations could be ground
s

for revocation of the permit.


Applicant

Signature
:

________________________________________________
_ Date
: _________
_________
SOIL EROSION AND SEDIMENTATION CONTROL

PERMIT APPLICATION

City of Jefferson and
Talmo


City of Jefferson Department of Planning and Development

147 Athens Street

Jefferson, GA 30549

Phone: 706/367
-
5011

Fax: 706/367
-
5134



Name of Project: ___
_______________________________________

Subdivision: _____________________________________________

Street Address: ___________________________________________

Tax Map: ______ Parcel: _____ Existing Buildings?: Yes ____ No ____

Proposed Use: ______
______________________________________

Applicant Name: __________________________________________

Address: ________________________________________________

City/State/Zip: ___________________________________________

Phone Number: ____________________
_______________________

Contact Person: ___________________________________________

Phone Number: ___________________________________________

Owner’s Name: ___________________________________________

Address: __________________________________________
______

City/State/Zip: ___________________________________________

Phone Number: ___________________________________________









_____________________________







Applicant’s Signature


Note: Applicant must submit four (4) complete E & S plans wi
th application.


For Office Use Only:


Application Date: _______________


Received by: __________________


Application Fee: ________________

Receipt No.: __________________





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OCONEE RIVER SOIL & WATER CONSERVATION DISTRICT

90 Lanthier Street, Suite C

Winder, Georgia 30680

Telephone (770) 307
-
3030






TO:


Applications for Land Disturbing Activity Permits

FROM:

Oconee River Soil and Water Conservation District

DATE:

_________________________

SUBJECT:

Erosion and Sediment Control Plan Review


A cons
ervation education contribution of $
4
0.00 per Erosion and Sediment Control Plan is requested by the
Oconee River

Soil and Water Conservation District. This is in addition to any charges by the local issuing
authorities.


Upon receipt of first contribution
, the district will provide the individual/business with an affiliate
membership.


Complete

the following and attach a check in the amount of $
4
0.00 payable to
Oconee River

Soil and Water
Conservation District.


____________________________________

__
____________________________

Project Name






County


____________________________________

Applicant Name


____________________________________

Address


____________________________________

Phone Number


To help us in processing your application mail chec
k and this form within five (5) days to:


Oconee River Soil & Water Conservation District

ATTN: Susan Peppers

P.O. Box 1663

Winder, Georgia 30680







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JEFFERSON
-

TALMO

PLANNING AND DEVELOPMENT

R
epresenting the Cities of
Jefferson and Talmo


DEVELOPMENT R
EVIEW FEES




*
The fees below do NOT represent Building Permit Fees



**All fees are to be paid at the time of submittal



***Re
-
review fess shall be based upon consultant’s fees to be paid at time of permit/approval issuance.


Project Name:___________________
_______________________________________________


Date Submitted:____________________________













FEE

Erosion & Sedimentation Control Review

Total disturbed acres for the project _________

Cost = $100.00 per acre or fraction thereof (minimum of $
100.00)



$

Concept Sketch Plan Review/ Submittal

Cost = $500.00 per project


$

Preliminary Plat/Site Plan Review

Residential and Commercial

Number of Lots _____________

Cost = $500.00 or $20.00 per lot, whichever is greater




$

Environmental Fee

Cost
= $500 or $20 per acre, whichever is greater


$

***Fire Suppression Review

Cost of Major = $250.00

Cost of Minor = $50.00



$

***Water Plan Review

Residential and Commercial

Number of Lots _______________ (residential only)

Number of Acres _____________
_ (commercial only)

Cost for Residential = $500.00 or $20.00 per lot, whichever is greater

Cost for Commercial = $ 500.00 or $20.00 per acre, whichever is greater






$

***Sewer Plan Review

Residential and Commercial

Number of Lots _______________ (residential only)

Number of Acres ______________ (commercial only)

Cost for Residential = $500.00 or $20.00 per lot, whichever is greater

Cost for Commercial = $ 500.00 or $20.00 per acre, whichever is greater






$

***Was
tewater Lift Station Review

Cost of Duplex Pump Station = $1,000.00

Cost of Triplex Pump Station = $1,500.00



$

***Oil and Grease Separator OR Grease Trap Plan Review

Cost = $700.00


$

***Pre
-
treatment Plan Review

Cost = $1,500.00


$

***Stormwater Rev
iew

Residential and Commercial

Number of Lots _______________ (residential only)





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Number of Acres ______________ (commercial only)

Cost for Residential = $500.00 or $20.00 per lot, whichever is greater

Cost for Commercial = $ 500.00 or $20.00 per acre, whic
hever is greater



$

Final Plat Review

Residential and Commercial

Number of Lots _________________

Cost = $250.00 or $10.00 per lot, whichever is greater




$

TOTAL REVIEW FEES

$