Renewal Application for Storm Water Management Operational License/Permit
	Project Name	
	Project Location / Address		

	Folio/PCN		-		-		-			
	Property Owner Contact
Name Address
Phone and Email	
	Responsible Maintenance Entity
Property Owner	Management Company	Other	
Contact Name Address

Phone and Email	
	Certifying Engineer Contact
Name Address
Phone and Email License No.	
	Fee:	$750 Review, Process and Inspect (includes up to 2 outfalls)
+$100 for each outfall in excess of 2	
	The following documents are required to be submitted: permit fee, engineer’s certification, system map, and maintenance records. It is the owner’s and engineer’s responsibility to be familiar with the renewal requirements of the storm water management operational license. Applicant understands that the District will not issue a new operational license until all outstanding field items are complete, certification accepted and fees paid.	
	Signature of Applicant	Signature of Owner	
			
	Type or Print Name	Type or Print Name