Do I need a notary for the Responsible Land Disturber Designation?

No. The designated person signs and dates the form without a notary. Include a copy of the person's license or certificate.

When is a responsible land disturber required?

Richmond requires applicants for permits involving land-disturbing activities to provide the responsible land disturber's name before the permit is issued.

What information does the form request?

It requests the responsible land disturber's name, signature, date, license or certificate details, expiration date, telephone and fax numbers, email, and mailing address.

Richmond, VA · City of Richmond

No notary required

Designation of Responsible Land Disturber

This form designates the responsible land disturber for a Richmond land-disturbing activity permit and is completed by the person taking responsibility for the work.

What this form is

Richmond requires applicants for permits involving land-disturbing activities to provide the name of a responsible land disturber before the permit is issued. The designated person signs to accept responsibility for carrying out the permitted activities and provides contact details, license or certificate information, and its expiration date. A copy of the license or certificate must accompany the form.

Who needs it

Applicants for Richmond permits involving land-disturbing activities need a designated responsible land disturber before the permit is issued.

How to submit it

Submit the completed form and a copy of the license or certificate to the Department of Public Utilities Water Resources Division, 730 East Broad Street, 8th Floor, Richmond, VA 23219.

About notarization

This document is signed without a notary; the designated person signs and dates it and submits a copy of their license or certificate.

How to submit this form

1
Download The Form
Download the Designation of Responsible Land Disturber form.
2
Complete The Form
Enter the project location and permit number, then provide the responsible land disturber's information and signature.
3
Gather The Attachment
Include a copy of the responsible land disturber's license or certificate.
4
Submit To The City
Submit the form and copy to the Department of Public Utilities Water Resources Division at the address printed on the form.

Frequently asked questions

Do I need a notary for the Responsible Land Disturber Designation?: No. The designated person signs and dates the form without a notary. Include a copy of the person's license or certificate.
How do I submit the Responsible Land Disturber Designation?: Send the completed form and a copy of the license or certificate to the Department of Public Utilities Water Resources Division at 730 East Broad Street, 8th Floor, Richmond, VA 23219.
When is a responsible land disturber required?: Richmond requires applicants for permits involving land-disturbing activities to provide the responsible land disturber's name before the permit is issued.
What information does the form request?: It requests the responsible land disturber's name, signature, date, license or certificate details, expiration date, telephone and fax numbers, email, and mailing address.

Need something notarized?

This Designation of Responsible Land Disturber doesn’t need a notary — but if you have another Richmond form that does, a commissioned online notary can help.