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Eastern Washington Phase 11 Municipal SYornnvater Permit <br />Line -by-line Instructions <br />Part 1— Owner/Operator information <br />A. Applicant information - Fill out the name and mailing address of the city, county, or public <br />entity that will receive coverage under the permit. <br />B. Responsible Official or Representative — Fill out the name, address and contact information for <br />the principal executive officer or ranking elected official responsible for signing the <br />application. See Part 8 for more information. <br />C. Billing information - If a separate department or office handles billing, enter the appropriate <br />contact information. There is an annual permit fee associated with this permit. <br />D. Primary Contact person - Enter the name, title, address, phone number, and email for the <br />person who will be in charge of developing the stormwater management program and meeting <br />the stormwater permit requirements. <br />E. Ownership status - Check the appropriate box indicating the ownership status (e.g., city, <br />county, or special district type). <br />Part 2 -- Permit(s) under which the applicant is requesting coverage <br />Check the box that corresponds to the permit(s) under which you are applying for coverage. The <br />geographic locations covered by each permit break down as follows: <br />• Phase I — covers entities within, or partially within the unincorporated areas of CIark, King, Pierce, <br />or Snohomish counties; or the cities of Seattle or Tacoma. <br />• Phase II Western Washington — covers entities in the census -defined urban areas of western <br />Washington, and associated urban growth areas, some cities with populations over 10,000 or areas <br />otherwise designated by Ecology. <br />• Phase II Eastern Washington — covers entities in the census -defined urban areas of eastern <br />Washington, and associated urban growth areas, and some cities with populations over 10,000 or <br />areas otherwise designated by Ecology. <br />Note: Applicants may submit a single NOI to request coverage of all of the MS4s that they own or <br />operate. For example, a single NOI may be submitted to cover the main campus and any satellite <br />campuses of a university that may require permit coverage. Applicants requesting coverage for <br />multiple sites/locations must list the locations for each site/location for which coverage is being <br />requested. When more than one permit is checked, Ecology will consult with the applicant to <br />determine whether to assign all the sites to separate permits or to one permit that will provide <br />coverage. <br />Part 3 — Population served by the MS4 <br />Provide an estimate of the population served by the MS4 within the geographic area(s) covered by the <br />permits. Cities, towns, and counties include only the resident population. For special purpose districts <br />and other public entities that are not cities, towns, or counties, the estimate must include both resident <br />and commuter populations. For example, a university may have a resident population of students who <br />live on campus and a commuter population of students and employees who commute to campus. (See <br />above for information on determining the commuter population in Who does not need to apply?) <br />Part 4 — Map requirements <br />A. Is part of the MS4 located within Indian Country (within a reservation or on land held in trust <br />for a tribe)? For the Puyallup reservation only, check "yes" if MS4 is located on trust lands and <br />August 1, 2014 Appendix 5 - Nolice gflnteW.for Coverage Page 3 of 6 <br />