WATAB
Submit Application & Fees To:
Watab Township
8900 Lakewood Shore Rd NW
Rice, MN 56367
Land Disturbance Permit Application
** Application fee is to be paid
upon permit approval**
New Single Family
Small Construction
Commercial Site
Large Development
(over 5 acres)
Contact Pat Spence, Township Clerk &
MS4 Administrator, with questions:
$0
$300
$2,000
$3,750
Phone: (320) 224-8242
watabts@qwestoffice.net
Pursuant to the requirements of the Ordinance Establishing Erosion Control and Stormwater Management Requirements for Land
Disturbances and Water Quality of Watab Township, the undersigned hereby applies for a permit for the land disturbing activity as
indicated hereon and represented by the approved plans. The primary goal of this ordinance is to establish standards and
specifications for conservation practices and planning activities to minimize soil erosion and sedimentation and regulate
construction site erosion and stormwater runoff. This permit may be revoked if inspection reveals non-compliance with the plan.
Applicant is:
 Owner
 Contractor
 Other (describe)
Property Owner
Name:
Phone:
Street Address:
City:
Phone:
Email:
Project/Property Information
Location/Address:
Parcel ID#:
Estimated Start Date:
Description of Work:
Land Disturbance Size:
If the disturbed area is 1 acre or larger, have you applied for a MPCA NPDES Permit?
Contractor
Company Name:
Company Phone:
Address:
Contact Name:
Contact Email:
Contact Phone:
Engineer/Designer (if applicable)
Company Name:
Address:
Contact Name:
Contact Email:
Contact Phone:
(OVER)
Submittals (To view the permit review checklist: www.watabtownship.com)
Applicant MUST submit ALL plan sheets involving Stormwater BMP’s, drainage maps, and calculations. At a minimum the
SWPPP with BMP’s must be submitted. Additional items submitted to supplement the SWPPP may include: engineering
plans, drainage/area maps, permanent Stormwater BMP information, etc.


Stormwater Pollution Prevention Plan (SWPPP)
Other Submittals Included: __________________________________________________________
Signature:
The undersigned agrees that by signing of this application obligates the Applicant and Contractor to adhere to any and
all ordinances and regulations adopted by the Township of Watab as well as requests for further protection as deemed
necessary by an employee or agent of the Township of Watab, Benton County, or the State of Minnesota. The
undersigned accepts full responsibility for compliance with the Ordinance Establishing Erosion Control and Stormwater
Management Requirements for Land Disturbances and Water Quality of the Township of Watab and agrees to comply
with the Stormwater Pollution Prevention Plan or equivalent in full. Additionally, right of entry onto this property to the
Township of Watab, its employees or agents, for the purpose of ordinance enforcement is granted.
_____________________________________________________________
Signature of Applicant
________________________________
Date
This permit is hereby released by the Township of Watab on ______________________________________, subject to
the conditions of the Stormwater Ordinance and any special conditions attached.
_______________________________________________________________
Signature of Township
________________________________
Date
This permit is permissive only and does not release the Permittee from any liability or obligation imposed by Minnesota
Statute, Federal Law, State Agency Rules, or the requirements of other agencies with regulatory authority.
Special Conditions:
Land Disturbance Permit Number: _________________
Date Received: _________________________________
Date Paid: _____________________________________
Permit Effective Date: ____________________________
SWPPP PLAN
Please sketch your lot shape and complete a diagram of your Stormwater Pollution Prevention Plan using the
Example Residential Stormwater Pollution Prevention Plan (SWPPP). If your lot is on the lake, river, or wetland,
please indicate the distance it is from the water. Also, include any storm sewers or culverts adjacent to your
property.