West Jordan City Engineering Department

Clearing and Grubbing Limited Land Disturbance Permit Application & Agreement

Engineering Department · 7960 South 4000 West, West Jordan, Utah 84088 · Phone: 801-569-5070

Application fee: $165.00

Applicant information

Date

Name of applicant

Mailing address

Phone

Project information

Please check one

Subdivision

Site Plan

Other

Location of land disturbance

Purpose of land disturbance

Cubic yards

Square feet

Required submittals

Please provide the following with your application.

Preliminary title report evidencing the applicant is the vested owner of the subject property
Final engineering grading plans reviewed and accepted by the City
Separate engineering drawings and specifications defining the nature, extent, and location of clearing and grubbing activities
Revegetation Plan
Separate revegetation and restoration bond to ensure the site will be restored to an acceptable condition
Stormwater Pollution Prevention Plan (SWPPP)

Terms and conditions of approval

Any land disturbance permit for clearing and grubbing limits the work to that identified on the separate set of engineering drawings and specifications submitted and approved for clearing and grubbing.

The applicant must notify the City Engineer or the Engineering Inspector twenty-four (24) hours in advance before any work is started.

The City may stop work if: (1) the work exceeds that identified in the clearing and grubbing plans and specifications; (2) there is a suspected violation of any applicable law or term and condition herein; or (3) the City determines in its sole discretion that there is a risk to the health and safety of the public.

Utility and site protection requirements

Applicant is required to blue stake the area and consult utility companies operating therein before any excavation. In granting any permit, the City makes no representation as to the location of utility facilities in the area that may be excavated or the impact of the permitted activities on said utilities.

Prior to beginning any land disturbance activities, the applicant shall protect the property with barriers identifying which trees can and cannot be removed. These barriers must be inspected by the City prior to commencement of work.

Applicant shall apply appropriate tackifier to dirt stockpile if requested by the City of West Jordan and shall maintain all erosion control measures.

Applicant certification

The undersigned agrees to: (1) perform the excavation applied for in a professional manner and in conformity with applicable law and City specifications; (2) timely respond to adjacent property owners to address all concerns; and (3) defend, indemnify, and hold harmless the City and its officers, agents, employees, and volunteers from claims, liabilities, actions, causes of action, suits, demands, warranties, rights, losses, damages, punitive damages, costs, expenses, and compensation of any kind and nature whatsoever arising from the City’s issuance of a permit or any work performed thereunder.

Applicant and its contractor are jointly and severally liable for any damages caused by exceeding the scope of the clearing and grubbing plans.

Signature section

Signature of applicant

Date

Signature of applicant’s contractor

Date

City engineer section

City Engineer

Date

This section is reserved for City staff.

Privacy Notice: The personal data being collected is included in a public record as defined under Utah Code 63G-2-301 and may be available to the public as provided in Utah Code 63G-2-201. Prior to making a record available to the public, the City of West Jordan redacts private, protected, or controlled information as defined in Utah Code 63G-2-302, 304, and 305. For more information, please contact the City’s Data Privacy Officer, tangee.sloan@westjordan.utah.gov.