City of Ocean Springs            PERMIT NO.___________



Applicant: ________________________________ Tel. No. ____________________________

Property Owner _______________________________________________________________

Location _____________________________________________________________________

Mailing Address _______________________________________________________________

Temporary Housing Description:  Single Unit ______ Multiple Unit Site ______# of Units _____

Manufactured Home______  Rec. Vehicle Tow______    Rec. Vehicle Self Propelled ______

Make _________________   Model _____________   Year ___________   Size ____________

Recreational Vehicles for tow must have access to a vehicle capable of the load requirements:

Make ___________   Model _____________  Owner of vehicle _________________________

Connection to City or Public Utilities:  Water_____ Sewer _____   Elec.______ Nat. Gas______

Self-Contained, Non-Connected:  Water ______ Sewer ______   Elec._______ Nat. Gas______

If not connected to utilities, please describe access (disposal of sewage must be documented): ____________________________________________________________________________


I, the undersigned, certify that the above information is true and accurate, and I understand and agree that the temporary housing unit shall not be allowed to become a permanent structure and will remove said unit upon expiration of permit (extensions included) or certificate of occupancy for permanent structure and will comply with other provisions as detailed in the Hurricane Katrina Temporary Housing Regulations.


Applicant Signature________________________________________   Date _______________



Provide copy of temporary housing regulations:  _______________           Zoning District: ________ Obtain signature on Hold Harmless Agreement: _______________            Flood Zone (Y/N): _______ 

Water/Sewer Access: ________   Pub. Works Director Approval: ________________________

Electricity Available:            __________ Electric Co. Approval (via telephone):  ___________________

Multiple Unit Site: ____________            Planning Director Approval:  __________________________

Number of Units:_____________ Mayor Approval:  ___________________________________

Expiration of Permit:  October 2, 2006 ________  

Self-Contained, Non-Connected expires in 30 days of this permit ___________ 

Issued by _______________________________________________  Date ________________