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4. St. Joseph County Drainage Board

   & Robert Kruszynski, County Surveyor

5. Date*
   Date
7. Urban Drain Petition
9. STATE OF INDIANA
   COUNTY OF ST. JOSEPH
10. )
    )
11. TO THE COUNTY SURVEYOR
    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.

47. Submit Submit and Print

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