Owner’s Name:

Phone Number:

Property Address:

Parcel No:

Email:

Stormwater Exemption Checklist:

Check for $25 payable to Sadsbury Township

Sign and Date Ownership Acknowledgement (listed below)

Fill out Exemption Form below

Attached sketch of the property including proposed improvements (see sample sketch)

Exemption Requirements:

An applicant proposing the cumulative installation of 1,000 square feet or less of impervious surface coverage proposed after May 6, 2014 may be exempt from the design, plan submittal, and processing requirements of the Sadsbury Township Stormwater Management Ordinance.

Exemption Form:

Determine the total area to be managed (ft2) including roof, driveway, walk, patio and/or other impervious area.

Length(ft)

Width(ft)

Impervious Area(ft2)

Length(ft)

Width(ft)

Impervious Area(ft2)

Length(ft)

Width(ft)

Impervious Area(ft2)

Length(ft)

Width(ft)

Impervious Area(ft2)

Length(ft)

Width(ft)

Impervious Area(ft2)

(a) Sum of all impervious area

(b) Subtract any impervious area being removed

*Total area to be managed (a) – (b)

Exemption Amount Remaining (ft2):

Owner Acknowledgement – I declare that I am the property owner and that the information provided is accurate to the best of my knowledge.  I understand that stormwater may not adversely affect adjacent properties or be directed onto another property without written permission.  I also understand that false information may result in a stop work order or revocation of any associated permits.  Township representatives are also granted reasonable access to the property for review and/or inspection of this project as necessary.

Signature:

Clear

Date:

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