Fillable PIMA COUNTY FLOODPLAIN USE PERMIT APPLICATION (Pima County Government)

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PIMA COUNTY FLOODPLAIN USE PERMIT APPLICATION (Pima County Government)

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1/26/2017
PIMA COUNTY FLOODPLAIN USE PERMIT APPLICATION
PIMA COUNTY REGIONAL FLOOD CONTROL DISTRICT
201 North Stone Avenue, 9
TH
FLOOR
TUCSON, ARIZONA 85701-1207
(520) 724-4600
TO BE FILLED OUT BY APPLICANT (PLEASE PRINT CLEARLY):
DATE
TOWNSHIP
S
RANGE
E
SECTION
TAX CODE
PROPERTY OWNER’S LAST NAME
PROPERTY OWNER’S FIRST NAME
PROPERTY OWNER’S PHONE NUMBER
APPLICANT’S LAST NAME
APPLICANT’S FIRST NAME
APPLICANT’S PHONE NUMBER
OWNER’S E-MAIL ADDRESS
CITY
STATE
AZ
ZIP
CITY
STATE
ZIP
APPLICANT’S E-MAIL ADDRESS
SUBDIVISION AND LOT NUMBER OR PARCEL LEGAL DESCRIPTION
DESCRIPTION OF WORK (A site plan DRAWN TO SCALE and showing ALL proposed work must be attached)
DESCRIPTION OF SUPPORTING INFORMATION BEING SUBMITTED
IF THIS PERMIT IS FOR A STRUCTURE, METHOD OF PROTECTION FROM FLOODING MUST BE INDICATED (CHECK ALL THAT APPLY)
If residence has an attached garage, is the garage FFE below the elevation of the residence? (CIRCLE ONE) Yes No
ELEVATED ON FILL WITH
10 FT STD DESIGN
DUMPED RIP-RAP: □
GROUTED RIP-RAP: □
ENGINEERED DESIGN: □
ELEVATED ON STEM
WALL (DOES NOT INCL.
BLOCK SKIRTING)THAT
IS:
__
BACKFILLED □
FLOOD-VENTED □
ELEVATED ON PIERS: _
REINFORCED CMU PIER: □
JACK STAND w/FOOTER: □
SKIRTING TYPE:
NONE/BREAK-AWAY □
BLOCK/NONBREAK-AWAY □
VENTED AND/OR □
FLOODPROOFED______
_
BLDG AREA(SQFT):_____
SHOW SIZE/LOCATION OF
VENTS ON SITE PLAN)
OTHER (EXPLAIN)
By signing this application, the undersigned requests written authorization
pursuant and subject to the
requirements of FLOODPLAIN MANAGEMENT ORDINANCE, 2010-FC5 for the project described above. Undersigned
agrees to
abide by all c
onditions contained or referred to herein and to indemnify, defend, and hold harmless Pima County and
the Flood Control District and their agents from and against any and all suits, claims
, or demands associated with
this permit.
Undersigned acknowledges that this application constitutes a request for inspection of the project
site by District staff prior to permit issuance, during construction, and upon completion of the project.
Undersigned acknowledges that the District has provided information regarding the application process.
APPLICANT SIGNATURE
Technical Procedure 102: Site Plan Requirements
(http://rfcd.pima.gov/rules/pdfs/tech102.pdf
)
Technical Policy 003: Minimum Construction Requirements for Manufactured Home Foundations in Floodway Fringe Areas
(http://rfcd.pima.gov/rules/pdfs/tech003.pdf
)
Technical Policy 005: Construction Standards for Solid Walls and Continuous Fences within Regulatory Floodplains
(http://rfcd.pima.gov/rules/pdfs/tech005.pdf
)
Technical Policy 006: Erosion Protection for Fill Pads
(http://rfcd.pima.gov/rules/pdfs/tech006.pdf
)
Technical Policy 011: Permitting of Accessory Structures
(http://rfcd.pima.gov/rules/pdfs/tech011.pdf
)
Technical Policy 014: Erosion Protection of Stem Wall Foundations
(http://rfcd.pima.gov/rules/pdfs/tech014.pdf
)
Technical Policy 021: Use of Flood Resistant Materials Below the RFE
(http://rfcd.pima.gov/rules/pdfs/tech021.pdf
)
Technical Policy 022: Use of Flood Openings or Vents Below the RFE
(http://rfcd.pima.gov/rules/pdfs/tech022.pdf
)
Technical Policy 023: Allowable Uses of Enclosed Areas with Flood Openings
(http://rfcd.pima.gov/rules/pdfs/tech023.pdf
)
Technical Policy 027, Protective Measures for Private Vehicular Access
(http://rfcd.pima.gov/rules/pdfs/tech027.pdf
)
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PIMA COUNTY FLOODPLAIN USE PERMIT APPLICATION (Pima County Government)

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Completed 18 July 2020

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