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Earth Change Permit Application

  1. This application is in conformance with the provisions as outlined in Sapulpa City Code, Part 12, Chapter 7 (Earth Change Regulations). The fee for an Earth Change Permit is $30.

  2. Applicant Information

  3. If different from applicant

  4. Does the applicant have permission from the owner to request earth changes?*

  5. Contractors - Land Disturbing & Land Filling Activities

  6. Types of Earth Change / Construction Activities*

    Check all that apply

  7. Square Feet

  8. Describe the nature of construction / earth moving activities

  9. Provide names, if applicable, and locations

  10. Is lot or tract in a floodplain?*

  11. Is a survey required?*

    If yes, you will need to attach the survey and include 3 sets of drawings at scale.

  12. If you do not have engineering site plans, please upload a drawling of a Vicinity Map. Include proposed placement of sediment and erosion control best management practices, surrounding watercourses, and existing building structures. The application will not be processed without a site map indicating the sediment and erosion control placement.

  13. Certification Statement

    "I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage this system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

    I have read and agree to comply with all requirements of Sapulpa City Code, Part 12, Chapter 7 attached to the Earth Change Permit."

  14. Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.

  15. Fee Schedule For Earth Change/sediment and Erosion Control Permit Within the City Of Sapulpa, Oklahoma

  16. Flood Plain Administrator

  17. Urban Development Director

  18. Environmental Administrator

  19. Leave This Blank:

  20. This field is not part of the form submission.