Floodplain Development Permit Application Page 2
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APPLICATION #_____________
PAGE
DESCRIPTION OF WORK (Check all applicable boxes):
A. STRUCTURAL DEVELOPMENT:
ACTIVITY
STRUCTURE TYPE
□ New Structure
□ Residential (1-4 Family)
□ Addition
□ Residential (More than 4 Family)
□ Alteration
□ Non-residential (Dry Floodproofing? □ Yes)
□ Relocation
□ Combined Use (Residential & Commercial)
□ Demolition
□ Manufactured Home (In a Manufactured Home Park? □ Yes □ No)
□ Replacement
□ Accessory Structure
B. OTHER DEVELOPMENT ACTIVITIES:
□ Fill
□ Mining
□ Drilling
□ Grading
□ Excavation (Except for Structural Development Checked Above)
□ Watercourse Alteration (Including Dredging and Channel Modifications)
□ Drainage Improvements (Including Culvert Work), Stormwater Control Structures or Ponds
□ Road, Street or Bridge Construction
□ Subdivision (New or Expansion) □ Manufactured Home, Recreational Vehicle or Trailer Park
□ Individual Water or Sewer System
□ Other (Please Specify)________________________________________________________________
C. ESTIMATED COST OF PROJECT: $_________________
After completing SECTION 2, APPLICANT should submit form to Local Floodplain Administrator for review.
SECTION 3: FLOODPLAIN DETERMINATION
(To be completed by LOCAL FLOODPLAIN
ADMINISTRATOR)
The proposed development is located in the Town / Village / City of ___________________________________
on FIRM Panel No. _____________________, Dated ________________.
□ The proposed development site is reasonably safe from flooding (in Zone B, C or X).
(Notify the applicant that NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED.)
□ The proposed development is located partially or completely in a “special flood hazard area.”
Base flood elevation at the site is: __________Ft. □ NGVD 1929 / □ NAVD 1988 / □ other datum
(describe) ________________________________
□ Unavailable
Required flood protection level is: __________Ft. □ NGVD 1929 / □ NAVD 1988 / □ other datum
(describe) ________________________________
__________Ft. above the highest adjacent grade
□ The proposed development is located in a regulatory floodway.
FBFM or FIRM Panel No.__________________________ Dated______________
□ See Section 4 for additional instructions for development that is or may be in a flood prone area.
SIGNED (by LOCAL ADMINISTRATOR) ____________________________________ DATE_____________
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