Form Center

2. Name
3. Email Address
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
12. Fax Number
14. Contractor's Name
15. Contractor's Address
17. Contractor's Address
19. Type of Permit

    1. Downspout
    2. Driveway Culvert/Roadside Conduit
    3. Ditches
21. DOWNSPOUT
23. Pipe Size

    1. 3"
    2. 4"
    3. Other
24. Drainage to include:

    1. Roof
    2. Sump
    3. Surface
    4. Sub-surface
25. Curb Cut

    1. Yes
    2. No
    3. Existing
27. DRIVEWAY CULVERT/ROADSIDE CONDUIT
29. Length
30. Pipe Diameter
31. Distance from edge of roadway
33. Headwall Needed?

    1. Yes
    2. No
34. Plans attached
36. DITCHES
38. Length
39. Distance from edge of roadway

41. I hereby agree to all terms, conditions and restrictions written or printed below and to the Drainage Regulations of Delhi Township, including the precautions for the protection of the public and all utilities within the public right-of-way and to any and all installations in and around said drainage construction or reconstruction.  If work done under this permit involves or endangers structures belonging to others.  I shall immediately notify the owner.

    This permit may at any time be revoked or annulled by the Delhi Township Permit Department for non-performance and/or non compliance with any of the conditions, restrictions, and/or regulations.  Violations of a non-compliance of said regulations are subject to penalties provided by Sections 5589.10 and 5591.26 of the Ohio Revised Code.

    Pans and/or application must be approved and permit secured before commencing work.  Delhi Township regulations require that you notify the Delhi Township Permit Department in writing or call (513) 922-8609 (between 7:00 AM and 9:00 AM forty eight hours before starting construction

43. 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.
45. Electronic Signature
46. Date Submitted
    Date Submitted
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