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2. If you need assistance with this application, need a translator, or would like this application mailed to you through the postal service, please contact us at stormwater@carrboronc.gov or 919-913-2999.
4. First Name*
5. Last Name*
6. Email
8. Street Address*
9. Mailing Address (if different)
11. City*
12. State*
13. Zip*
15. Phone*
16. Type*
    -- Select One --CellHomeWork
17. Phone
18. Type
    -- Select One --CellHomeWork
20. Preferred Method of Contact

    1. Phone call

    1. Text

    1. Email
22. Race (You may select more than one.)

    1. White
    2. Black or African American
    3. American Indian or Alaska Native
    4. Asian
    5. Native Hawaiian or Other Pacific Islander
    6. Other (Specify in the box below.)
23. Ethnicity

    1. Hispanic
    2. Not Hispanic
25. Specify Race if you checked Other above.
27. Do you own your home?*

    1. Yes
    2. No
28. Is your property in the Town limits?*

    1. Yes
    2. No
    3. I don't know.
29. Is there a stream on your property?*

    1. Yes
    2. No
    3. I don't know.
31. Do you have an active land use or building permit application for this property?*

    1. Yes
    2. No
    3. I don't know.
33. What property concerns would you like assessed? (Check all that apply.)*

    1. Flooding and drainage around house
    2. Yard flooding after heavy rains
    3. Persistent wet/poorly drained areas
    4. Managing runoff from rooftop, driveway, etc.
    5. Managing runoff entering or exiting property
    6. Installing a rain garden

    1. Streambank stabilization
    2. Riparian (streamside) improvements
    3. Managing erosion
    4. Rainwater harvesting
    5. Landscaping improvements (e.g., terracing, lawn conversion, soil enhancement, native plantings, invasive plant management)
    6. Other
35. Please provide a brief description of what you would like assessed.
37. If you are filling out this application on behalf of someone else, please fill out your information below.
39. First Name
40. Last Name
41. Phone
43. By submitting this application, I affirm that all of the above information is correct to the best of my knowledge. I also understand that this application does not guarantee that I will receive an assessment nor does it obligate the Town or its assignees to any other specific action.
45. Initials*
46. Date*
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 Submit and Print

* indicates a required field