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2. *DEPARTMENT USE ONLY

   Development permit No________________________:

6. Application Date:*
   Application Date:
8. Site Address1*
10. Parcel #:
11. Lot #:
13. Property Owners Name:*
15. Owners Address:*
17. City
18. State
19. Zip
21. Applicant Name:*
22. Applicant Phone No:*
23. Applicant Email:*
25. Contractor Name:
26. Registration No:
28. Flood Plain Zone:
    -- Select One --Flood Fringe 100yrFlood Fringe 500yrFloodway
30. Description of Work:*
    -- Select One --New ConstructionAdditionAlterationOther
31. Dimension of Foundation:

    FT x FT = SQFT AREA 

32. Lower Floor Elevation:

    Including basement

34. Appropriate Use:*

    1. Non-Residential
    2. Residential
    3. Accessory Structure
    4. Mobile Home

    1. Bridge/Culvert/Roadway
    2. Underground Utility
    3. Filling/Mining/Dredging
    4. Other
35. YEAR BUILT:
37. Proposed Construction Cost: $*

    Provide Architect's/Engineer's/Contractor's Estimate

38. Value of Existing Structure: $*

    Provide County Auditor's Tax Card

40. Proposed Flood Protection Method:*

    1. FILLING ABOVE 100-YEAR ELEVATION: Elevation of Top of Fill (NAVD) (Attach Registered Architect's/Engineer's Certification)
    2. LOW FLOOR ELEVATION ABOVE 100-YEAR ELEVATION: (Attach Registered Architect􀂶s Certification; Submit Surveyor􀂶s Certification upon completion of floor)
    3. FLOODPROOFING (Attach plans showing methods and elevations with Registered Architects Signature and Seal)
    4. NON-SUBSTANTIAL IMPROVEMENT (Must be Pre-FIRM structure)
    5. RESIDENTIAL ACCESSORY STRUCTURE < 576 SQ. FT. (Provide anchoring and flood vent details)
    6. TIE DOWNS
    7. OTHER

    Check all that apply

42. OTHER:
46. CERTIFICATION (Read, Sign, Date, and Attach any Supporting Documents)

    The undersigned hereby makes application for a permit to develop in a special flood hazard area as delineated on the Federal Emergency Management Agency's Flood Insurance Rate Maps current on the date of the application. The work to be performed is described on this application and in attachments hereto. The undersigned agrees that all such work shall be done in accordance with the requirements of the Flood Damage Prevention Ordinance, Chapter 1331, of the Codified Ordinances of the City of Lancaster, Ohio and with all other applicable local, state and/or federal laws. The undersigned further agrees to provide the necessary as-built construction plans and/or certification to verify compliance with the aforementioned Flood Damage Prevention Ordinance. 

    The undersigned understands that approval of this permit does not relieve the applicant of his/her obligation to obtain all other necessary permits from local, state and/or federal agencies.

48. Owner's Signature:*
49. Date:
    Date:
51. Applicant's Signature:*
52. Date:*
    Date:
54. Upload Supporting Documents

    Or email plans to buildingsubmittal@ci.lancaster.oh.us or building@ci.lancaster.oh.us

58. *Administrative Use Only
60. FLOOD DAMAGE PREVENTION STANDARDS:
61. APPLY
62. EXEMPT
64. BASE FLOOD ELEVATION (100 Year Event):

    NAVD

66. PERMIT APPROVED BY:_____________________________________

    TITLE:_________________________________________

68. ADDITIONAL PERMIT FEES: $
69. DATE PERMIT ISSUED:

    
    

    
    

71. PERMIT DENIED FOR THE FOLLOWING REASONS:
    • Application Permit Incomplete
    • Technical Evaluation Missing or Incomplete
    • Certification of Registered Surveyor/Engineer/Architect missing
    • Other ____________________
73. YOUR RECOURSE TO THE DENIED PERMIT IS:
    • Resubmit With Necessary Information and Attachments
    • Change Location of Structure and Reapply
    • Apply for Variance with Board of Zoning Appeals
    • Technical Evaluation per L.C.O. 1331.14
    • Other __________________________

    
    

Leave This Blank:


74. 1. Receive an email copy of this form.
75. Email address

    This field is not part of the form submission.

76. Submit

* indicates a required field