Form Center

2. Property Information
4. Street Address:*
5. City/State:*
6. ZIP:*
8. Primary Applicant Information
   Note: The primary applicant bust be the Owner of the property above, or an Official Representative of the HOA.
10. First Name:*
11. Last Name:*
12. Email:*
14. Phone Number:*
15. Is the applicant's address different from that listed above?*
    -- Select One --YesNo
17. Street Address:*
18. City/State:*
19. ZIP:*
21. Other applicants?*
    -- Select One --YesNo
23. Project Details
25. Proposed Best Management Practice*

    1. Rain Barrel ($50 maximum)
    2. Best Management Practice
    3. Drain Tile
    4. Streambank Stabilization
    5. Other
26. Please select the planned Best Managment Practice(s):*

    1. Soil Quality Restoration
    2. Rain Garden
    3. Bio-Retention Cell
    4. Native Landscaping
28. For reimbursements to be awarded documents showing the following information for all projects must be submitted via email to stormwater@waukee.org,

    1. Map/site plan showing the project location and area it will treat
    2. Project summary/description
    3. Cost summary or contractor estimates
    4. Construction Schedule including the expected completion date
30. Project Schedule
32. Approximate Project Start/Finish Dates*
    Approximate Project Start/Finish Dates Start Date

    —

    Approximate Project Start/Finish Dates End Date
34. Estimated Project Cost
36. Project Cost Attachments*
    Attach detailed breakdown of items. Grant amount is not to exceed 50% of project costs or $5,000 per property. Only out of pocket expenses will be considered; property owner’s time or labor will not be reimbursed.
38. Materials:*
39. Contract Labor:*
40. Other:
41. Total Cost:*
43. ACKNOWLEDGEMENT
    By signing this agreement, the property owner agrees to the terms of the Stormwater Grant Program, including the conditions for reimbursement and for keeping the grant in good standing. If the terms of the Stormwater Grant Program are not met at any time, the grant may be revoked and reimbursement denied.
45. Primary Applicant's Electronic Signature*
46. Date*
    Date
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field