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 Septic (provide copy of permit) Water / __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 sets 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 Sheet 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 Notice of Intent filed with the State; □ Copy of receipt 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 ordinances, pertaining to and in accordance with any plans submitted. I understand failure to comply with these regulations could be grounds 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 with application. For Office Use Only: Application Date: _______________ Application Fee: ________________ Received by: __________________ Receipt No.: __________________ 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 conservation education contribution of $40.00 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 $40.00 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 check and this form within five (5) days to: Oconee River Soil & Water Conservation District ATTN: Susan Peppers P.O. Box 1663 Winder, Georgia 30680 D:\533571215.doc JEFFERSON - TALMO PLANNING AND DEVELOPMENT Representing the Cities of Jefferson and Talmo DEVELOPMENT REVIEW 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 ***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 ***Wastewater 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 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 Final Plat Review Residential and Commercial Number of Lots _________________ Cost = $250.00 or $10.00 per lot, whichever is greater TOTAL REVIEW FEES D:\533571215.doc $ $ $ $ $ $ $ $ $ $ $ $ D:\533571215.doc