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WATER QUALITY PROTECTION CHARGE NON-RESIDENTIAL and MULTI-FAMILY RESIDENTIAL CREDIT APPLICATION
Regulated by the Code of Montgomery County Regulations (COMCOR) 19.35.01.05
Montgomery County Department of Environmental Protection

APPLICANT MUST ATTACH A COPY OF PROPERTY TAX BILL AND ALL SUPPORTING DOCUMENTATION INCLUDING PHOTOS OF THE PRACTICES FOR THE CREDIT NOT LATER THAN OCTOBER 31 OF THE YEAR BEFORE PAYMENT OF THE CHARGE IS DUE.
Property Information
Property Account No:* Owner Name:*
Premise Address:* Phone Number:
Owner/Agent Address: Phone Number (Premise):*
Email Address: I am the:*
(If Authorized Agent, please attach copy of document creating authorization at bottom of application)
Application Checklist


On-Site/Off-Site Treatment Information*
*This information should be located in computations for Options 1 or 2, and must be provided for Option 3, unless research is requested.
Total Impervious Area of the Site: (square feet)
Stormwater Management System
(Facility Type– see list in Attachments)
Year of Installation
(yyyy)
Facility Size Facility Size Units
(gallons, square feet)
Impervious Area (sf) Treated by Facility
On-Site Off-Site
Total  
Upload Supporting Documents and Images:*
By signing this form, you certify that (1) you have read and understand the WQPC Credit Program Requirements; (2) the information provided on this form is complete and factual; (3) the stormwater management system(s) on your property have been maintained and are in proper working order; and (4) you grant the County permission to conduct site inspections of the stormwater facilities listed on this form.
By checking this check box, I *sign this application.
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