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6. NATURE OF CONSTRUCTION ACTIVITY <br />Check the appropriate box(s) or provide a brief description that indicates the general nature of the construction activities. (The full <br />description of activities must be included in the Stormwater Management Plan.) <br />i i Single Family Residential Development <br />o Multi-Family Residential Development <br />o Commercial Development <br />a Oil and Gas Production and/or Exploration (including pad sites and associated infrastructure) <br />o Highway/Road Development (r,? including roadways associated with commercial or residential development) <br />e Other, Describe: Reservoir and Water Transfer System <br />7. ANTICIPATED CONSTRUCTION SCHEDULE <br />Construction Start Date: January 2011 Final Stabilization Date: January 2012 <br />8. RECEIVING WATERS If discharge is to a -ditch or storm sewer include the name of the ultimate receiving waters <br />immediate Receiving Water(s): Riverview Ditch and Arkansas River <br />Ultimate Receiving Water(s): Arkansas River <br />9. REQUIRED SIGNATURES (Both parts 1. and ii, must be sinned) <br />aevuat rru m rwppncamu i no applicant must be either the owner and/or operator of the construction site. Refer to Part B of the <br />Instructions for additional information. The application must be sinned by the applicant to be considered complete. all <br />cam, it shall be signed as followrs- <br />a) In the case of corporations, by a principal executive officer of at least the level of vice-president or his or her duly <br />authorized representative, if such representative is responsible for the overall operation of the facility from which the <br />discharge described in the application originates. <br />b) In the case of a partnership, by a general partner. <br />c) In the case of a sole proprietorship, by the proprietor. <br />d) In the case of a municipal, state, or other public facility, by either a principal executive officer, ranking elected offica 1, <br />or other duly authorized employee N such representative is responsible for the overall operation of the facility from <br />which the discharge described in the form originates. <br />STOPI: A Stormwater Mammement Plan must be completed prior to signing the following certificationsl <br />1. Stormwater Managentertt Plan Certification <br />'I certify under penalty of law that a complete Stormwater Management Plan, as described in Appendix A of this application, has been <br />prepared for my activity. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for <br />gathering the information, the Stormwater Management Plan is, to the best of my knowledge and belief, true, accurate. and complete. 1 am <br />aware that there are nificant penalties for falsely certifying the completion of said SWMP, including the possibility of fine and <br />imprisonment fork <br />vts %&? via s <br />ti 9/3obo <br />Signature of Legally Respo 'b a Pe on or Authorized Agent (submission must include original sianaturet natp cinno.i <br />Name (printed) <br />ii. Signature of Permit Legal Contact <br />Title <br />'1 certify under penalty of law that I have personally examined and am familiar with the information submitted in this application and all <br />attachments and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the <br />information Is true, accurate and complete, 1 am aware that there are significant penalties for submitting false information, including the <br />possibility of fine or imprisonment. <br />'1 understand that submittal of thte application is for coverage under the State of Colorado General Permit for Stomhwater Discharges <br />Associated with Construction Activity for the entirety of the construction shelpmject described and applied for, until such time as <br />the application Is amended or the certification is transferred, inactivated, or expired <br />Signature of Legally Responsible person (submission must include original signature) Date Signed <br />Title - <br />DO NOT INCLUDE A COPY OF THE STORMWATER MANAGEMENT PLAN <br />DO NOT INCLUDE PAYMENT - AN INVOICE WILL BE SENT AFTER THE CERTIFICATION IS ISSUED. <br />Page 3 of 3 <br />Revised 412010