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Eastern Washinglon Phase H Municil)al Storniwater Perinit <br />E. Ownership Status <br />check appropriate box <br />❑ City or Town <br />❑ County <br />❑ Federal <br />❑ Federally -recognized Indian Tribe <br />Special Purpose District:(secondary permittee) <br />❑ Diking/drainage district ❑ Port <br />❑ Flood control district ❑ University i <br />❑ Public school district ❑ Park district <br />❑ State agency (give name) <br />❑ Other (please describe) <br />Part 2 — Permits under which the applicant is requesting coverage (see instructions) <br />❑ Phase I Municipal Stormwater Permit <br />❑ Western Washington Phase II Municipal Stormwater Permit <br />❑ Eastern Washington Phase II Municipal Stormwater Permit <br />If you own or operate MS4s that are located in areas covered by more than one permit, please list the <br />locations of all of the MS4s for which you are requesting permit coverage. <br />Part 3 — Population served by the MS4 <br />Estimated resident population (public entities that are not cities, towns, or counties also include <br />commuter populations) served by the MS4 within the geographic area(s) covered by the <br />permits: <br />Part 4 — Map(s) <br />A. Is part of the MS4 located within Indian Country (within a reservation or on land held in <br />trust for a tribe)? For the Puyallup reservation only, check "yes" if MS4 is located on trust <br />lands and "no" if any part of the MS4 is located on fee lands. ❑ Yes ❑ No <br />B. For special purpose districts only, attach a map or maps delineating the geographic area <br />served by the MS4. ❑ Attach map(s) to this form <br />❑ Not applicable <br />Part 5 — Co -Permittee information <br />Complete this part of the NOI only if you are applying as a Co -Permittee with another entity to <br />meet the requirements of the permit. Permittees that apply as Co -Permittees are responsible for <br />meeting permit conditions related to their discharge(s). <br />If you are applying with another entity or entities as Co-Permittee(s) please include, as an <br />attachment to this NOI, a summary of the permit obligations that will be carried out jointly among <br />Co -Permittees. The summary must identify the other Co-Permittec(s) and must be signed by the <br />other Co-Permittee(s). . <br />August 1, 201.1 Appme ix 5 - Notice of Inleni f )r C'owrage Page 3 of 5 <br />