Urban Drain Petition

4. St. Joseph County Drainage Board
   & John R. McNamara, P.E., L.S. County Surveyor

   & John R. McNamara, P.E., L.S. County Surveyor

5. Date*
   Date

7. Urban Drain Petition

9. STATE OF INDIANA
   COUNTY OF ST. JOSEPH

   COUNTY OF ST. JOSEPH

10. )
    )

    )

11. TO THE COUNTY SURVEYOR
    ST JOSEPH COUNTY, INDIANA

    ST JOSEPH COUNTY, INDIANA

13. IN THE MATTER OF PETITION FOR:*

    FOR CLASSIFICATION AS AN URBAN DRAIN IN THE COUNTY DRAINAGE SYSTEM OF ST. JOSEPH COUNTY

15. We the undersigned, being the owners or representing the owners of the property described below, desire that the proposed*

    Subdivision drainage system be classified as an Urban Drain, subject to the jurisdiction of the St. Joseph County Drainage Board, pursuant to the 1965 Indiana Drainage Code, as amended. The benefits are greater than the cost.

17. Acreage:*

18. Number of Lots:*

19. Parcel Key Number:*

20. Parcel Key Number:

22. Subdivision Location:*

24. General Route of the Drain:*

26. Legal Description:*

30. Name*

31. Name

    (Internal Use Only)

33. Address*

34. Address

36. City*

37. Zip*

38. City

39. Zip

41. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
43. Signature

Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

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