BOX ELDER COUNTY FLOODPLAIN DEVELOPMENT PERMIT
BOX ELDER COUNTY FLOODPLAIN DEVELOPMENT PERMIT Permit Number:
FIRM Zone:
Elevation of the Year Flood:
The Base Flood Elevation at the project site is: NAVD NGVD Local Ordinance Elevation/Flood proofing Requirement: Chapter 5-4, Flood Damage Prevention FEMA (Ordinance 346) Elevation Certificate: (attach a copy of elevation certification or flood proof certificate) Lowest Floor Elevation: Elevation to which Structure is to be Flood Proofed: ISSUED TO: Property Owner(s) Name(s)
E-Mail
Phone
Address, City, State, Zip
Size of Property
PROJECT LOCATION:
Name of water body at location of activity
Project Address
Legal Description
TYPE OF DEVELOPMENT – Check all areas that describe the type of activity proposed NEW BUILDING Residential Non-Residential Manufactured Home Rehabilitation Accessory
EXISTING STRUCTURE Alteration Vertical Addition Horizontal Addition Accessory Materials Storage
SITE WORK Filling/Grading/Levee Mining/Dredging/Excavating Bridge/Culvert Alteration/Channelization Other-List
Description of Development/Purpose of Project:
*Attach Source Documents: Reports/Floodplain Maps *Attach a Site Plan *Attach a floodplain map with proposed project noted on it Value of Improvement (fair market):
Pre-Improvement/Assessed Value of Structure $:
OTHER PERMITS REQUIRED Corps of Engineer 404 Permit State Department of Natural Resources 401 Permit Environmental Protection Agency NPDES Permit
YES
NO
PROVIDED
SIGNATURE Property Owner(s)
Date
In accepting this permit, the applicant understands that all conditions of the permit must be met, all other regulatory permits have been obtained, an elevation certificate will be provided once the project is completed, and agrees to allow on-site inspections, as needed during or after construction to determine compliance with this permit. The applicant understands and agrees that: *This permit is issued on the condition and facts described; *Any permit may be repealed if conditions of facts change, *Permit is void if activity has not begun within 180 days of the issuance date, *The permit will remain valid for one year from date of issuance, and *Elevation certification form must be finished and returned at time construction is completed. PERMIT APPROVAL/DENIAL
Plans and Specifications Approved/Denied this ________ day of ____________________, 20_____. Signature of Authorizing Official _________________________________________, Floodplain Administer.
Department Use Only:
Inspection #:_____________ by: ________________________ Inspection #:_____________ by: ________________________ Inspection #:_____________ by: ________________________ Inspection #:_____________ by: ________________________
Checklist: ___ ___ ___ ___ ___ ___ ___ ___ ___
Site Development plan is complete and depicts flood hazard Engineering data is provided for proposed map and floodway revisions Floodway Certification and data document no increase in flood heights Subdivision proposal minimizes flood damage and protects utilities Lowest floor elevation is at or above the BFEs Manufactured homes meet elevation and anchoring requirements Are utilities (furnace, water heater, air condition unit, etc.) at or above the BFEs A flood proofing certificate certifies flood proofing designs. Elevation Certificate is attached
FIRM Zone:
Elevation of the Year Flood:
The Base Flood Elevation at the project site is: NAVD NGVD Local Ordinance Elevation/Flood proofing Requirement: Chapter 5-4, Flood Damage Prevention FEMA (Ordinance 346) Elevation Certificate: (attach a copy of elevation certification or flood proof certificate) Lowest Floor Elevation: Elevation to which Structure is to be Flood Proofed: ISSUED TO: Property Owner(s) Name(s)
Phone
Address, City, State, Zip
Size of Property
PROJECT LOCATION:
Name of water body at location of activity
Project Address
Legal Description
TYPE OF DEVELOPMENT – Check all areas that describe the type of activity proposed NEW BUILDING Residential Non-Residential Manufactured Home Rehabilitation Accessory
EXISTING STRUCTURE Alteration Vertical Addition Horizontal Addition Accessory Materials Storage
SITE WORK Filling/Grading/Levee Mining/Dredging/Excavating Bridge/Culvert Alteration/Channelization Other-List
Description of Development/Purpose of Project:
*Attach Source Documents: Reports/Floodplain Maps *Attach a Site Plan *Attach a floodplain map with proposed project noted on it Value of Improvement (fair market):
Pre-Improvement/Assessed Value of Structure $:
OTHER PERMITS REQUIRED Corps of Engineer 404 Permit State Department of Natural Resources 401 Permit Environmental Protection Agency NPDES Permit
YES
NO
PROVIDED
SIGNATURE Property Owner(s)
Date
In accepting this permit, the applicant understands that all conditions of the permit must be met, all other regulatory permits have been obtained, an elevation certificate will be provided once the project is completed, and agrees to allow on-site inspections, as needed during or after construction to determine compliance with this permit. The applicant understands and agrees that: *This permit is issued on the condition and facts described; *Any permit may be repealed if conditions of facts change, *Permit is void if activity has not begun within 180 days of the issuance date, *The permit will remain valid for one year from date of issuance, and *Elevation certification form must be finished and returned at time construction is completed. PERMIT APPROVAL/DENIAL
Plans and Specifications Approved/Denied this ________ day of ____________________, 20_____. Signature of Authorizing Official _________________________________________, Floodplain Administer.
Department Use Only:
Inspection #:_____________ by: ________________________ Inspection #:_____________ by: ________________________ Inspection #:_____________ by: ________________________ Inspection #:_____________ by: ________________________
Checklist: ___ ___ ___ ___ ___ ___ ___ ___ ___
Site Development plan is complete and depicts flood hazard Engineering data is provided for proposed map and floodway revisions Floodway Certification and data document no increase in flood heights Subdivision proposal minimizes flood damage and protects utilities Lowest floor elevation is at or above the BFEs Manufactured homes meet elevation and anchoring requirements Are utilities (furnace, water heater, air condition unit, etc.) at or above the BFEs A flood proofing certificate certifies flood proofing designs. Elevation Certificate is attached
