APPLICATION MATERIALS - Laserfiche WebLink

Exhibit A FORM O & M: OPERATIONS & MAINTENANCE PLAN REQUIRED IN ACCORDANCE WITH THE CITY CODE Project Building Application Owner's Name: Phone No. Mailing Address: Site Address: Site Map and Tax lot No. Requirements 1) Stormwater Management Site Plan, (min. 8'/z" x 11" attached to this form) showing the location of the facility(ies) in relation to building structures or other permanent monuments on the site, sources of runoff entering the facility(ies), and where stormwater will be discharged to after leaving the facility(ies). The stormwater management facility(ies) shown on the site plan are a required condition of building permit approval for the identified property. The owner of the identified property is required to operate and maintain the facility(ies) in accordance with the Operations and Maintenance (O&M) Plan on file with the City. The O&M Plan for the facility(ies) is/are available at the Public Works Department, located at 1820 Roosevelt, Eugene, Oregon between the hours of 8 a.m. and 5 p.m., Monday through Friday. Call (541)(682-4800). 2) Description of the financial method used to cover future operations and maintenance. Check One Homeowner's Association Q Property Owner Account Q Other (described) 3) Party(ies) responsible for maintenance (only if other than owner). Daytime Phone no. Emergency/After-hours contact phone no. - Maintenance Contact party(ies) Name & Address: 4) Maintenance practices and schedule for the stormwater facility is included in the facility- specific O&M Plan filed with the Public Works Department, City of Eugene. The operation and maintenance practices are based on the publication date of the City of Eugene's Stormwater Management Manual. Preparation Date: 20_ Revision Date: 20_ Estimated Date of Installation 20` By signing below, filer accepts and agrees to the terms and conditions contained in the operations & maintenance plan and in any document executed by filer and recorded with it. Signature of Filer: Print Name: