OWNER

Applicant: ________________ __

Address -------------------------------

A. Locations of the land to be

drained: ------------------------------------------------------------

Township name: ______________________________ _

Size of area being drained: __________________________ _

Proposed rate of water flow: -----------------------------------------------

Source of water to be drained: ---------------------------------------------

B. Briefly explain the type of drainage proposed (open; covered; depth; length;

Etc.): ---------------------------------------------------------

How will the dredged or iillmaterial be disposed of? ________________ _

Who designed the project? _________________________ _

Estimated project cost: ____________ .

C. Describe the proposed route of flow (include initial points and general course:

Illustrate the drainage on the township map): ___________________ __

List the names and addresses of all servient landowners within two mile of where the water will exit

your property.

Name Address

(if more r00111 is needed, use the back of this sheet.)

What makes this project necessary? ____________________ _

Will the project have an impact on the following? If yes, explain below.

-public health,

safety and welfare

-pollution

-flood and storm

hazards

-sedimentation and

erosion

-water supply

-water quality

-water recharge

and discharge

Yes No

Owner's Signature ___________________________ _

OfliccUse

- Date Received - Fee paid _____ _

Map attached ____ _

CONTRACTOR

Contractor -----------------------------------------------

Address, _____________________________________ _

A, Are you or your firm bonded? __________ _

B, Location of project: ________________________________________________________ _

Describe the work you will perform on the proposed drainage project: ___________ _

Estimated dollar value of your work: ________________________ _

C, Certification, I have read and am familiar with Brule County's drainage ordinance and land use

plan,

Signature _________________ _

Date ----------------------

Office Use

Date received _________ _

Fee paid, ____ _