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4. St. Joseph County Drainage Board
5. Date*
   Date
7. Non-Regulated Drain Obstruction Complaint Form
9. The petitioner must supply the following:
   A $500.00 NON-REFUNDABLE FILING FEE IS REQUIRED AND THE APPLICATION WILL NOT BE PROCESSED UNTIL PAYMENT HAS BEEN MADE WITH THE COUNTY SURVEYOR'S OFFICE.
11. Name of Person Filing Complaint*
12. Property Owner's Name*
14. Address*
15. Address*
17. State*
18. Zip*
19. State*
20. Zip*
22. Tax Parcel & Deed #*
23. Contact Number*
25. A copy of the certified receipt and letter from you to the landowner requesting the removal of the obstruction that is causing you damage will need to be submitted to the Drainage Board.
27. Type of Drain:*
    -- Select One --OPEN DITCHTILEOVERLAND WATERWAYCOMBINATION
28. Definition of Drain:*
    -- Select One --MUTUAL DRAINPRIVATE DRAIN
30. Give "General Direction" of the drain in question.*
32. Give a brief narrative of why the obstruction should be removed and the damage being caused. Include size and type of obstruction.*
34. Contact all permitting agencies to see if permits will be required to perform work to remove or to repair the obstruction.
    (Agency list below)
36. U.S. Fish & Wildlife
    Ecological Services Field Office (812) 334-4261
37. DNR
    Indiana Department of Natural Resources (317) 232-4200
38. Army Corp of Engineers-Michiana Branch Office
    (574) 232-1952
39. Indiana Dept. of Environ. Management (IDEM)
    (800) 451-6027
41. The St. Joseph County Surveyor's office and the Drainage Board may or may not find the petitioner's claim to be valid under Senate Bill #336.
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

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