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Floodplain Development Permit Application

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APPLICATION #_____________

PAGE

FLOODPLAIN DEVELOPMENT PERMIT APPLICATION

SECTION 1: GENERAL PROVISIONS

(APPLICANT to read and sign)

No work may start until a permit is issued. This includes grading.

The permit may be revoked if any false statements are made herein.

If revoked, all work must cease until permit is re-issued.

Development shall not be used or occupied until a Certificate of Compliance is issued.

The permit is invalid if no work is commenced within six months of issuance, and expires 2 years from

date of issuance.

Applicant is hereby informed that other permits may be required to fulfill local, state and federal

regulatory requirements.

Applicant hereby gives consent to the Local Floodplain Administrator or his/her representative to make

reasonable inspections required to verify compliance.

I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO

THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND ACCURATE.

(APPLICANT'S SIGNATURE) ____________________________________ DATE ________________

SECTION 2: PROPOSED DEVELOPMENT

(To be completed by APPLICANT)

NAME

ADDRESS

TELEPHONE

APPLICANT

___________________________________________________________________________________________

BUILDER

___________________________________________________________________________________________

ENGINEER

___________________________________________________________________________________________

PROJECT LOCATION:

To avoid delay in processing the application, please provide enough information to easily identify the project

location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance

to the nearest intersecting road or well-known landmark. A map attached to this application, and a sketch showing

the project layout would be helpful.

Floodplain Development Permit Application