Commercial Property Downspout Disconnect Application

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SECTION,3: Property Lnformafiion- Downspouts PropertV Type ❑ Commercial Total number of external downspouts: Total number of internal downspouts ❑ Industrial (i.e. not visible from outside of ❑ Institutional Number disconnected from city sewer: property): ❑ other Number connected to city sewer: Indicate if your building: ❑ Has an internal only roof drainage system: ❑ Is a registered historic structure: ❑ The property is within or adjacent to a wetland or wellheads. The information you provide in this section, (Section 3) is required for record Keeping by the City and to assist in verifying your application, it will not directly influence the applicable 1LDP fee for this property. A: The total birds -eye square footage of my property, as listed at the above address is (please provide this information in the box to the right): B: The amount, in square feet, that I can prove, does not emit any run-off (rain water or snow melt) into the City sewer is: C: The square footage listed in A, minus that stated and proven in B is: D: Connected Square footage C, multiplied by $0.61 (61 cents) is: ] $ is amount is the fee to join the In -lieu of Disconnect Program Remember, if under point B above you are claiming that part of your property is not connected the onus is on you to clearly, thoroughly, and overwhelmingly beyond doubt demonstrate that fact. The evidence supporting your claim must be submitted along with this application form. An engineering drawing should be submitted. Next, complete the declaration on the next page (page 6) and submit this completed form to: Department of Public Works In -Lieu of Disconnect Program, 227 W Jefferson Blvd., #1316 South Bend, IN 46601.