FLOOD HAZARD AREA DEVELOPMENT PERMIT APPLICATION
For the unincorporated areas of Clark County, Ohio
Application is hereby made for a DEVELOPMENT PERMIT as required by the Special Purpose
Flood Damage Reduction Regulations of Clark County, Ohio, for development in an identified flood
hazard area. All activities shall be completed in accordance with the requirements of said
regulations. The development to be performed is described below and in attachments hereto. The
applicant understands and agrees that:
The permit applied for, if granted, is issued on the representations made herein;
Any permit issued may be revoked because of any breach of representation;
Once a permit is revoked all work shall cease until the permit is reissued or a new permit is issued;
Any permit issued on this application will not grant any right or privilege to erect any structure or sue
any premises described for any purposes or in any manner prohibited by the resolutions, codes, or
regulations of the County;
The applicant hereby gives consent to the Floodplain Administrator to enter and inspect activity
covered under the provisions of the floodplain regulations;
If issued, the Flood Hazard Area Development Permit form will be posted in a conspicuous place on
the premises in plain view; and,
If issued, the permit will expire if no work is commenced within one year of issuance.
Application Information
Name:________________________________________
Address:______________________________________
City/State/Zip:__________________________________
Phone:_________________Fax
: _______________
Developer Information
Name:______________________________________
Address:____________________________________
City/State/Zip:________________________________
Phone:_________________Fax:_________________
LOCATION OF DEVELOPMENT SITE
1. Site Address:_______________________________________________________________
Township: _________________________
2. Legal Description/Parcel No.
__________________________________________________________________________
Attach a location map showing the location of the development site relative to adjacent sites.
Show the location of the development on the site with distances to all lot lines.
APPLICATION FEE: $150.00 Make check payable to “Clark County Community & Economic Development
DESCRIPTION OF WORK
3. Kind of development proposed (check all that apply):
Residential Structure Non-residential structure
New Structure New Structure
Addition to structure Addition to structure
Renovations/repairs/maintenance Renovations/repairs/maintenance
Manufactured home installation Accessory structure: Dimensions________
Filling or grading Dredging or excavation or mining
Materials/equipment storage:
Describe Type________________________________________________________________
Watercourse alteration (any change that occurs within the banks of a watercourse)
Water supply/sewage disposal Bridge or culvert placement/replacement
Subdivisions greater than 50 lots or 5 acres Other development greater than 5 acres
Other:______________________________________________________________________
Additional activity description:______________________________________________________
4. If the proposed construction is an addition, renovation, repair or maintenance to an existing structure,
indicate the cost of proposed construction $__________________. What is the estimated market value of
the existing structure $________________________.
5. New structures & improvements to existing structures only:
a. Elevation of lowest floor, including basement ________feet.
b. Structure contains basement crawl space slab on grade
6. Structure will be flood protected by Adding fill to construction site.
Top of fill to be at elevation_________feet.
Floodproofing non-residential structure.
Certification of floodproofing methods attached Yes No N/A
Other Please specify____________________________________
7. If proposed development is the placement of a mobile home, what anchoring methods will be used:
Frame Over-the-top Certification of anchoring method attached Yes No
I AGREE THAT ALL STATEMENTS AND ATTACHMENTS TO THIS APPLICATION ARE A TRUE
DESCRIPTION OF THE EXISTING PROPERTY AND THE PROPOSED DEVELOPMENT ACTIVITY. I
UNDERSTAND THE DEVELOPMENT REQUIREMENTS FOR SPECIAL FLOOD HAZARD AREA ACTIVITES
PER THE APPROPRIATE RESOLUTION AND AGREE TO ABIDE THERETO. I ALSO AGREE TO ABIDE
BY THE ITEMS CONTAINED IN THE “NOTES AND ADDITIONAL SUBMITTAL REQUIREMENTS”
CONTAINED ON PAGE 3 OF THIS APPLICATION. I UNDERSTAND IT IS MY RESPONSIBILITY TO
OBTAIN ALL OTHER APPLICABLE FEDERAL, STATE AND LOCAL PERMITS.
Applicant’s Name (printed)_________________________________________________
Applicant’s Signature___________________________________________________ Date:_____________
NOTES AND ADDITIONAL SUBMITTAL REQUIREMENTS:
In addition to completion of this form the applicant agrees to submit any additional information required by the
floodplain administrator in order to determine that the proposed development is compliant with the local and
federal damage prevention criteria of the National Flood Insurance Program. Site plans for all development
proposals must:
Be drawn to scale with north arrow.
Show property boundaries, floodway, and floodplain lines.
Show dimensions of the lot.
Show dimensions and location of existing and/or proposed development on the site.
Show areas to be cut and filled.
Applications for residential and non-residential structures must also include:
The proposed lowest floor elevation based on the datum used on the effective Flood Insurance Rate
Map and base flood elevation for the site.
Identification of whether the structure has a basement or enclosure below the lowest floor, and if it
contains a basement or enclosure, detailed drawings showing foundation openings to allow passage of
flood waters.
Description of how building utilities will be protected from flood waters including drawings showing
locations of such utilities.
Detailed description of anchoring system for all mobile and manufactured homes.
Description of construction materials that will be used below the flood protection elevation.
An existing structure must comply with the flood protection standards if it is substantially improved (an
improvement equal to or greater than 50% of the market value of the structure). The “substantial improvement”
definition applies to existing structures only and that once a structure meets the definition of “new construction”
any further improvements to that structure must meet “new construction” requirements. For floodplain
management purposes “new construction” means structures for which “start of construction” began on or after the
effective date of the initial Flood Insurance Rate Map issued by FEMA for the community.
Any Pre-FIRM structure within the FHA that has sustained damage from any source (flood, fire, etc.) must be
elevated to determine if the structure is “substantially damaged” (damaged to 50% or more of the market value of
the structure). If the structure is “substantially damaged” the structure must be brought into compliance with the
flood protection standards.
For subdivision proposals greater than 5 acres or 50 lots, or large-scale developments greater than 5 acres, a
hydrologic and hydraulic analysis must be conducted to determine base flood elevations in flood hazard areas
where no base flood elevations are provided.
A Conditional Letter of Map Revision (CLOMR) must be obtained for proposed projects that would result in more
than a 1.0 foot increase in BFE on a watercourse that has been studied through detailed hydrologic and hydraulic
analyses where BFEs have been specified, but no floodway has been designated OR when a project proposed
(totally or partially within the floodway) along a watercourse for which detailed analyses have been conducted and
BFEs and a floodway have been designated would result in any (greater than 0.0 foot) increase in the BFE.
Applications for non-residential structures proposed to be floodproofed must have a completed FEMA
floodproofing certification form attached (can only be completed by a Registered Professional Engineer or
Architect).
All development proposals determined to be located in a floodway must be accompanied by a hydrologic and
hydraulic analysis showing impacts on the development of flood heights (can only be completed by a Registered
Professional Engineer).
Development proposals that are considered alterations of a watercourse must be accompanied by an analysis
showing that the flood carrying capacity of the watercourse has not been reduced.
This permit is: Approved Denied Filing Fee Paid: Yes No
If Permit is denied, reasons for denial:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________ ________________________
(Floodplain Administrator’s Signature) (Date)