Floodplain Permit

2. This form is used for any man-made change to improved or unimproved real estate, including, but not limited to buildings or other structures, mining, dredging, filling, grading, paving, excavation, drilling operations, or storage of equipment or materials. Developer must obtain all other necessary federal, state, or local permits (e.g. Corps of Engineers 404 Permit, Local Levee District, etc.)

4. First Name

5. Last Name

7. Address

9. City

10. State

11. Zip Code

13. Type and Use of Development

15. Specific Location of Development

17. Does the proposed development involve the improvement of a structure (i.e. walled and roofed building, manufactured home, or gas and liquid storage tanks)?

    1. Yes
    2. No

19. Pre-improvement Value of Structure

20. Cost of Improvement

24. The Following Section is to be Completed by the Community Official

26. Is the development Substantial Improvement? (see #4)

    1. Yes
    2. No

28. Is the development in an identified floodplain?

    1. Yes
    2. No

30. If YES, complete the following

32. Elevation of the Base (100-Year) Flood

    MSL/NGVD 29 or NAVD 88

33. Elevation/Floodproofing Requirement (if applicable)

    MSL/NGVD 29 or NAVD 88

35. Please note:

    1. I understand

    The developer may be required to submit hydraulic data demonstrating that the proposed development will not increase flood heights more than one foot at any location.

39. If the development is in a floodplain, the following shall apply:
    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 at least one foot above the base flood elevation. If the proposed development is a nonresidential building, this permit is issued with the condition that the lowest floor (including basement) of a new or substantially improved nonresidential building will be elevated or floodproofed at least one foot above the base flood elevation. The Developer/Owner will provide certification by a registered Engineer, Architect, or Land Surveyor of the “as-built” lowest floor elevation (including basement) or floodproofed elevation of any new or substantially improved building covered by this permit.

    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 at least one foot above the base flood elevation. If the proposed development is a nonresidential building, this permit is issued with the condition that the lowest floor (including basement) of a new or substantially improved nonresidential building will be elevated or floodproofed at least one foot above the base flood elevation. The Developer/Owner will provide certification by a registered Engineer, Architect, or Land Surveyor of the “as-built” lowest floor elevation (including basement) or floodproofed elevation of any new or substantially improved building covered by this permit.

41. All provisions of the City of Hebron Floodplain Management Resolution/Ordinance (Number Chapter 11 Article 2) shall be complied with.

43. Electronic Signature:*

    Please type your First and Last Name

44. Date*
    Date

    Date

46. Authorizing Official (Name & Title)

48. Agreement*

    1. I understand

    I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit Submit and Print

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