Flood Hazard Area Development Application Form - City Of Waterville

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FLOOD HAZARD AREA DEVELOPMENT PERMIT APPLICATION
Application is hereby made for a DEVELOPMENT PERMIT as required by the Special Purpose Flood Damage Reduction
Regulations, CH 1321, of City of Waterville for development in an identified flood hazard area. All activities shall be completed
in accordance with the requirements of said regulations.
The development to be performed is described below and in
attachments hereto. The applicant understands and agrees that:
The permit applied for, if granted, is issued on the representations made herein;
Any permit issued may be revoked because of any breach of representation;
Once a permit is revoked all work shall cease until the permit is reissued or a new permit is issued;
Any permit issued on this application will not grant any right or privilege to erect any structure or sue any premises
described for any purposes or in any manner prohibited by the ordinances, codes, or regulations of the municipality;
The applicant hereby gives consent to the Floodplain Administrator to enter and inspect activity covered under the
provisions of the floodplain regulations;
If issued, the FHA Development Permit form will be posted in a conspicuous place on the premises in plain view; and,
If issued, the permit will expire if no work is commenced within one year of issuance.
Owner's Name: ____________________________________ Builder/Developer: ____________________________________
Address:__________________________________________ Address: ____________________________________________
Phone:___________________________________________ Phone: _____________________________________________
LOCATION OF DEVELOPMENT SITE
1.
Location of proposed development site address:_____________________________________________________
2.
Lucas County Tax Parcel Number: ___ ___________________________________________________________
Attach a location map showing the location of the development site relative to adjacent sites. A location map may be a copy of
the tax or plat map, including scale, showing the parcel where development activity will occur.
DESCRIPTION OF WORK
3a. Kind of development proposed (check all that apply):
□ Residential structure
□ Non-residential structure
□ New structure
□ New structure
□ Addition to structure
□ Addition to structure
□ Renovations/repairs/maintenance
□ Renovations/repairs/maintenance
□ Manufactured home installation
□ Accessory structure: Dimensions:____________________
□ Filling or grading
□ Dredging or excavation or mining
□ Materials/equipment storage: Describe type _____________________________________________________
□ Watercourse alteration (any change that occurs within the banks of a watercourse)
□ Water supply / sewage disposal
□ Bridge or culvert placement / replacement
□ Subdivision greater than 50 lots or 5 acres
□ Other development greater than 5 acres
□ Other: ___________________________________________________________________________________
Additional activity description: ______________________________________________________________________
_______________________________________________________________________________________________
3b. If the proposed construction is an addition, renovation, repair or maintenance to an existing structure, indicate the cost of
proposed construction $_________________. What is the Lucas County Auditor’s 100% assessed value of the existing
structure $___________________?
4. City of Waterville Fee _________ Receipt # ______________ Date _________________
Flood Hazard Area Development Permit Application Page 1 of 2
NOTES AND ADDITIONAL SUBMITTAL REQUIREMENTS:

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