Muskingum County Floodplain Department
Floodplain Development
Permit Application
Please Fill Out This Form COMPLETELY
7. The applicant understands and agrees that:
This permit is issued on the conditions and facts described.
This permit may be repealed if conditions or facts change.
This permit is void if activity has not begun within 180 days of the issuance date.
The permit will remain valid for one year from the date of issuance.
2. Developer/Builder PERMIT FEE Structural
PERMIT FEE StructuralPERMIT FEE Structural
PERMIT FEE Structural
Non-Structural
StructuralStructural
Structural
Address City/State/Zip Make Checks Payable to:
Muskingum County Floodplain Department
Telephone Fax
8. If the proposed construction is an alteration, addition,
3. Project Address for 5a/5b repair or improvement to an existing structure, please
indicate the cost of the proposed construction.^
4. Legal Description of Land
Township_________ Section_____________ Parcel___________ ^ See back side of application for explanation
5a. Structural Activities: 9. What is the estimated market value of the existing
*Structural is any walled or roofed building, manufactured home structure?^
or gas or storage tank that is principally above ground in a
designated flood hazard area (mark those that apply) ^ See back side of application for explanation
New Alteration 10. Structure will be protected from flooding by:
Existing Addition Adding fill to construction site
Residential Accessory Piers, Pilings, Posts (circle)
Non-Residential Material Stor. Floodproofing (nonresidential)
Manufac. Home Tie Downs (mobile homes)
Solid Foundation Walls
5b. Non-Structural Activities *Other
*Non-Structural is any other activity within the designated flood *If other, please specify:
hazard area (mark those that apply)
11. If floodproofing the structure , what floodproofing
Excavation Lake/Pond techniques will be used?
Driveway Landscaping
Bridge Replace. Rip-rap
Agricultural levee Agricultural
Maintenance Land clearing
Other (specify)
6. If applicable, have the following permits been obtained?
12. Does the proposed development involve a subdivision
or other development containing 50 lots or more or 5 acres or more?
Health Department Permit
Township Permit (zoned townships) *Yes
County Planning Commission Subdivision Permit No
Corps of Engineers Section 404 Permit *
Corps of Engineers Section 10 Permit ** *NOTE: If yes, base flood elevation data is required from
Ohio EPA 401 Permit *** applicant if it has not been provided by FEMA
*
** See back side of this application for definitions.
I certify that all information I have provided is correct and realize that if the information is found to be false, the permit is void. I understand
the development requirments for special flood hazard area activities per the requirments of the Flood Damage Reduction of Muskingum County.
Compliance with the Flood Damage Reduction Resolution is necessary in order for residents to obtain flood insurance through the National Flood
Insurance Program (NFIP). I understand it is my responsibility to obtain all applicable federal, state, and local permits.
Signature of Applicant/Owner Date Revised 5/6/2010