INSTRUCTIONS FOR PERMIT APPLICATION

FOR

Proposed Development on Lands Located in a Location within Floodplain Areas

TO COMPLY WITH FLOODPLAIN MANAGEMENT REGULATIONS AND TO

MINIMIZE POTENTIAL FLOOD DAMAGE, IF YOU ARE BUILDING WITHIN AN IDENTIFIED FLOOD HAZARD AREA, YOU MUST AGREE TO CONSTRUCT YOUR PROPOSED DEVELOPMENT IN ACCORDANCE WITH THE FOLLOWING SPECIAL PROVISIONS:

SPECIAL FLOODPLAIN PROVISIONS:

1.      For RESIDENTIAL structures, the lowest floor (including basement) must be elevated 2 feet above the base flood elevation (100-year flood elevation).

See provisions for manufactured homes in local regulations.

2.      For NON-RESIDENTIAL structures, the lowest floor must be elevated 2 feet above the base flood elevation, or flood proofed to withstand the flood depths,

pressures, velocities, impact and uplift forces associated with the 100-year flood.

3.      For ALL STRUCTURES, the foundation and the materials used must be   

constructed to withstand the pressures, velocities, impact and uplift forces associated with the 100-year flood.

4.      All utility supply lines, outlets switches and equipment must be installed and

      elevated so as to minimize damage from potential flooding. Water and sewer

      connections must have automatic back flow devices installed.

5.   You must submit certification on the attached form(s) from a REGISTERED

       ENGINEER, ARCHITECT OR LAND SURVEYOR, that the floor

       elevation and /or flood proofing requirements have been met. Failure to

       provide the required certification is a violation of this permit.

6.      Other provisions – See attached list____________ None ______________

AUTHORIZATION

            I have read or had explained to me and understand the above special provisions for floodplain development. Authorization is hereby granted the permitting authority and their agents or designees, singularly or jointly, to enter upon the property described on the application during daylight hours for the purpose of making inspections or for any reason consistent with the issuing authority’s floodplain management regulation. I further verify that the information provided by me on the application is true and accurate to the best of my knowledge and belief.

_____________________________________

Signature of Applicant

PERMIT APPLICATION

For Proposed Development on Lands Located in a Location within Floodplain Areas

Date________________________                                                         Permit Number__________________________

Applicant _________________________________________________________________________________

Address __________________________________________________________________________________

Legal Description ___________________________________________________________________________

List Type and Purpose of Development ___________________________________________________________

Located ___________________________________________________________________________________

Is property to be located in an identified Special Flood Hazard Area (Regulatory Floodplain)?

                                Yes                                                      No           

If yes, complete the following and require certified elevation of lowest floor (including basement) and lowest adjacent grade.

Engineer __________________________________________________________________________________

Contractor _________________________________________________________________________________

Name of Community                                                            Unincorporated area of Canadian County

NFIP Community Number ______________________________________________________________________

Applicant Requests That (To):

 Construct           Mine   Construct Addition          Remodel             Elevate

 Drilling                Demolish            Manufactured Housing (Placement)

 Add Fill              Storage (Equipment or Supplies)

Base Flood Elevation _____________________Proposed Lowest Floor Elevation___________________________

Flood Map Effective Date ______________________________________________________________________

Flood Zone Type:                 A         B          C          X          Other

Community Panel No. _________________________________________________________________________

Lowest Finished Floor Elevation ________________                                Lowest Adjacent Grade _________________

Permit Fee ________________       Has permit fee been collected?           Yes      No

Plans, specifications and application for permit filed by the applicant shall constitute by reference a part of this permit.

Approved By _______________________________________________________________________________

Date ___________________________            ______________________________________________________

                                                                                                                                Signature of Applicant