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Land Disturbing Permit Application (For Sites 1 Acre or More)

2. Date
   Date

4. Name of Project*

6. Type of Land Disturbance*

   1. Residential
   2. Subdivision
   3. Multi-Family

   1. Commercial
   2. Industrial
   3. Other

8. Construction Address*

10. City*

11. State*

12. Zip Code*

14. Legal Description of Construction Property

16. Lot*

18. Block*

20. Addition*

22. Square Footage of Buildings & Asphalt/Concrete Coverage*

24. Lot Size*

28. Name of Applicant*

30. Applicant Address*

32. City*

33. State*

34. Zip Code*

36. Applicant Phone Number

37. Applicant Email

41. Name of Contractor*

43. Contractor Address*

45. City*

46. State*

47. Zip Code*

49. Contractor Phone Number*

50. Contractor Email

54. Name of Owner*

56. Owner Address*

58. City*

59. State*

60. Zip Code*

62. Estimated Area to Be Disturbed (square feet)*

66. Stormwater Management
    The Stormwater Program is responsible for ensuring Oklahoma's waterbodies are protected. City Ordinance, Parts 18, Chapter 4: Construction Activities requires a Land Disturbing Permit before the land is cleared.

    The Stormwater Program is responsible for ensuring Oklahoma's waterbodies are protected. City Ordinance, Parts 18, Chapter 4: Construction Activities requires a Land Disturbing Permit before the land is cleared.

68. Are there any creeks, wetlands or tributaries on the property?*

    1. Yes (If Yes, please submit site plan or sketch showing the locations of these waters.)
    2. No

70. Additional Permits That May Be Require
    <ul><li>404 Permit from Army Corp of Engineers for any disruption of any dry or wet tributary or creek.</li> <li>OKR10 Permit from DEQ for construction projects over one acre. Submit copy of SWP3.</li></ul><br>

    • 404 Permit from Army Corp of Engineers for any disruption of any dry or wet tributary or creek.
    • OKR10 Permit from DEQ for construction projects over one acre. Submit copy of SWP3.

    
    

72. Required Documents from the Department of Equality
    An OKR10 Stormwater Construction Permit must be obtained from Oklahoma Department of Environmental Quality (ODEQ) prior to any land disturbance activity. A Stormwater Pollution Prevention Plan (SWP3) is required in the OKR10 permit. This includes a Site Plan depicting erosion control and hazardous material locations. The SWP3 must be approved by ODEQ and the City of Tahlequah Stormwater Manager prior to the issuance of this Land Disturbing Permit. Visit the ODEQ for more information.

    An OKR10 Stormwater Construction Permit must be obtained from Oklahoma Department of Environmental Quality (ODEQ) prior to any land disturbance activity. A Stormwater Pollution Prevention Plan (SWP3) is required in the OKR10 permit. This includes a Site Plan depicting erosion control and hazardous material locations. The SWP3 must be approved by ODEQ and the City of Tahlequah Stormwater Manager prior to the issuance of this Land Disturbing Permit. Visit the ODEQ for more information.

74. Oklahoma Department of Equality
    Application information from the ODEQ

76. Please Provide the Following Documents
    <ul><li>SWP3 (Stormwater Pollution Prevention Plan).</li><li>Site Plan showing property lines, building footprint, drainage and/or detention, scale and North arrow.</li></ul><br> By clicking "Submit form" below, I am effectively providing my electronic signature authorizing the City of Tahlequah to begin the process(es) for the submitted application.

    • SWP3 (Stormwater Pollution Prevention Plan).
    • Site Plan showing property lines, building footprint, drainage and/or detention, scale and North arrow.

    
    By clicking "Submit form" below, I am effectively providing my electronic signature authorizing the City of Tahlequah to begin the process(es) for the submitted application.

78. Your signature
    Indicates you acknowledge and agree to implement the City of Tahlequah ordinance Part 18; Chapter 3: Illicit Discharges, Chapter 4: Construction Activities, and Chapter 5: Post Construction Activities. The Stormwater Manager is responsible for site inspections. Action upon noncompliance includes: stop work order, ($1000.00) one thousand dollar fine, suspension of water supply or action s set forth in the ordinance.

    Indicates you acknowledge and agree to implement the City of Tahlequah ordinance Part 18; Chapter 3: Illicit Discharges, Chapter 4: Construction Activities, and Chapter 5: Post Construction Activities. The Stormwater Manager is responsible for site inspections. Action upon noncompliance includes: stop work order, ($1000.00) one thousand dollar fine, suspension of water supply or action s set forth in the ordinance.

80. First Name

81. Last Name

83. Date
    Date

Leave This Blank:


85. 1. Receive an email copy of this form.
86. Email address

    This field is not part of the form submission.

87. Submit

* indicates a required field