HomeMy Public PortalAboutPERMIT APPLICATION: Construction Site Erosion and Sediment Control CONSESCO
City of Riverdale, Iowa
110 Manor Drive, Riverdale, Iowa 52722 (563) 355-2511 www.riverdaleia.org
CITY OF RIVERDALE, IOWA
CONSTRUCTION SITE EROSION AND SEDIMENT
CONTROL (COSESCO) PERMIT APPLICATION
PROJECT INFORMATION
Project Address
Subdivision
Lot/Parcel # Area of Disturbance: ☐ Under 1 acre ☐ Over 1 acre
Will geothermal wells be drilled on this site? ☐ Yes ☐ No
Description of Work
Estimated Start Date
Estimated Completion Date
OWNER INFORMATION
Name
Mailing Address
Phone
BUILDER INFORMATION
Name
Mailing Address
Phone
Email
TERMS
1. COSESCO permits are valid for one (1) year from the date of issue. If final stabilization is not achieved as
defined by the Iowa Department of Natural Resources (IDNR) in their General Permit #2, the permit must be
renewed. Operating without a valid permit is a violation and will result in a stop work order and associated
penalties.
2. This permit must be approved prior to any land disturbing activity.
3. The controls indicated on the Storm Water Pollution Prevent Plan (SWPPP) must be in-place, maintained,
and any changes recorded.
City of Riverdale, Iowa
110 Manor Drive, Riverdale, Iowa 52722 (563) 355-2511 www.riverdaleia.org
4. The applicant assumes all responsibility for the SWPPP and amendments and will certify the SWPPP
complies with all requirements of the COSESCO ordinance any state and/or federal requirements.
5. The applicant agrees to pay all fees associated with this permit.
6. By signing this document, the applicant certifies that all information submitted above is correct and the
applicant agrees to the terms.
APPLICANT CHECKLIST
Attached erosion control plan? ☐ Yes ☐ No
Attached detailed site plan including flow lines, track pad, sediment barriers, and
protection of any intakes or basins? ☐ Yes ☐ No
Reviewed and will you comply with all requirements of General Permit #2 from the
IDNR? ☐ Yes ☐ No
Read and understand the terms listed above? ☐ Yes ☐ No
Attached a residential $125, commercial, industrial, and utilities $200 application fee? ☐ Yes ☐ No
APPLICANT SIGNATURE
Signature Date:
Submit this form and attachments to:
Operations Manager, Public Works Department
City of Riverdale, Iowa
110 Manor Drive, Riverdale, IA 52722
operations@riverdaleia.org
(563) 949-0464
FOR OFFICE USE ONLY
Before a COSESCO permit can be issued, the following must be submitted by the applicant and approved by
the City of Riverdale, Iowa:
☐ Erosion control plan/SWPPP.
☐ Detailed site plan including flow lines, track pad, sediment barriers, and protection of any intakes or
basins.
☐ Completed application form.
☐ $125 Residential fee. $200 Commercial, industrial, and utilities.
Inspection Dates:
Inspected By:
City of Riverdale, Iowa
110 Manor Drive, Riverdale, Iowa 52722 (563) 355-2511 www.riverdaleia.org
Deficiencies Noted:
Permit Issued: ☐ Yes ☐ No Permit Number: