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Public Works

GESC Responsible Party Designation Form

GESC Responsibilty Party Designation
Property Address:*
Subdivision Name:*
GESC Permit Number:*
GESC File Number*
GESC Manager/Alternate GESC Manager
I have been designated the on-site GESC Manager/Alternate GESC Manager. I am responsible for maintaining and repairing all erosion and sedimentation controls on the approved site. It is my responsibility to ensure compliance with the GESC Manual, DESC Permit, and accepted DESC Plan. I additionally understand I shall be on-site the majority of the time and must be able to be reached by the contact information below:
GESC Manager Name/Electronic Signature
By typing your name below, you are signing this form electronically.
First Last
Date
MM slash DD slash YYYY
Company
Phone
Email
Alternate GESC Manager Name/Electronic Signature
By typing your name below, you are signing this form electronically.
First Last
Date
MM slash DD slash YYYY
Company
Phone
Email
Owner/Owner's Representative
I, being the owner/owner's representative, understand it is my responsibility to ensure my GESC Manager understands and complies with all applicable Douglas County Criteria and will ensure if I change contractors or the GESC Manager is removed from this project, the new contractor will contact Douglas County to become designated as the new onsite GESC Manager. I further understand the Permittee(s), as listed on the GESC Permit shall remain the legally responsible party(ies).
Owner Name/Owner's Representative/Electronic Signature
By typing your name below, you are signing this form electronically.
First Last
Date
MM slash DD slash YYYY
Company
Phone
Email