Floodplain Development Permit Application

Page 1

FLOODPLAIN DEVELOPMENT PERMIT/APPLICATION Application No.:

Date:

TO THE ADMINISTRATOR: The undersigned hereby makes application for a permit to develop in the Special Flood Hazard Area (SFHA) or “floodplain.” The work to be performed, including flood protection works, is as described below and in attachments hereto. The undersigned agrees that all such work shall be in accordance with the requirements of the Floodplain Management Ordinance and with all other applicable county/city ordinances, federal programs, and the laws and regulations of the State of Missouri. Owner or Agent

Date

Builder

Address

Address

Telephone Number

Telephone Number

SITE DATA 1.

Location:

1/4;

1/4; Section

; Township

; Range

Street Address: 2.

Type of Development: Filling

Grading

Routine Maintenance 3.

Description of Development:

4.

Premises: Structure Size

Excavation

Substantial Improvement

ft. By

Minimum Improvement

New Construction

ft.

Other

Area of Site

Sq. Ft.

Principal Use:

Accessory Uses (storage, parking, etc.):

5.

Value of Improvement (fair market): $

Pre-Improvement/Assessed Value of Structure: $

6.

Is the Property Located in a Designated FLOODWAY? Yes

No

IF ANSWERED YES, CERTIFICATION MUST BE PROVIDED PRIOR TO THE ISSUANCE OF A PERMIT TO DEVELOP, THAT THE PROPOSED DEVELOPMENT WILL RESULT IN NO INCREASE IN THE BASE (1%) FLOOD ELEVATIONS. 7.

Is the Property Located in a Designated Floodplain FRINGE or a Floodplain (SFHA) without a Designated FLOODWAY? Yes

No

8.

Elevation of the 1% Base Flood (ID source)

NGVD/NAVD

9.

Elevation of the Proposed Development Site

NGVD/NAVD

10.

Community Ordinance Elevation/Floodproofing Requirement

NGVD/NAVD

11.

NFIP Flood Insurance Rate Map Panel(s) Number(s)

12.

Other Permits Required?

Corps of Engineer 404 Permit: State Department of Natural Resources 401 Permit: Environmental Protection Agency NPDES Permit:

All Provisions of Ordinance Number

Yes Yes Yes

No No No

Provided Provided Provided

, the “Floodplain Management Ordinance”, shall be in Compliance.

PERMIT APPROVAL/DENIAL Plans and Specifications Approved/Denied this

Day of

, 20

Signature of Property Owner or Agent

Authorizing Official

Print Name and Title

Print Name and Title

THIS PERMIT IS ISSUED WITH THE CONDITION THAT THE LOWEST FLOOR (INCLUDING BASEMENT FLOOR) OF ANY NEW OR SUBSTANTIALLY IMPROVED RESIDENTIAL BUILDING WILL BE ELEVATED FOOT/FEET ABOVE THE BASE FLOOD ELEVATION. IF THE PROPOSED DEVELOPMENT IS A NON-RESIDENTIAL BUILDING, THIS PERMIT IS ISSUED WITH THE CONDITION THAT THE LOWEST FLOOR (INCLUDING BASEMENT) OF A NEW OR SUBSTANTIALLY IMPROVED NON-RESIDENTIAL BUILDING WILL BE ELEVATED OR FLOODPROOFED FOOT/FEET ABOVE THE BASE FLOOD ELEVATION. THIS PERMIT IS USED WITH THE CONDITION THAT THE DEVELOPER/OWNER WILL PROVIDE CERTIFICATION BY A REGISTERED ENGINEER, ARCHITECT, OR LAND SURVEYOR OF THE “AS-BUILT” LOWEST FLOOR (INCLUDING BASEMENT) ELEVATION OF ANY NEW OR SUBSTANTIALLY IMPROVED BUILDING COVERED BY THIS PERMIT. (MISSOURI) August 1, 2015