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1. Fill out this form completely. A separate application must be made for each separate property location. One application can be made for multiple stormwater detention/retention facilities to be inspected on the same property. Attach (or provide) a separate sheet giving parcel location, description and number(s) for each parcel for which you are requesting evaluation. 2. Fill out and provide a Right-of-Entry Form (Form 3).

Provide a separate sheet for each facility giving a sketch of the location and description

I hereby request consideration for impervious area evaluation and further authorize the City of Lima or their authorized representative(s) to inspect the above-identified stormwater facility(ies) for the purpose of investigation for a stormwater service fee adjustment. I certify that I have authority to make such a request and authorization for this property.