WASHINGTON COUNTY

Application for Floodplain Development Permit

DATE: ____________ APPLICATION No: ____________

Project Name:_____________________________________________________________________________

ADDRESS AND LOCATION OF DEVELOPMENT:

Section, Township, and Range:_________________________________________________________________

Address or name of road providing access:________________________________________________________

Parcel number(s):___________________________________________________________________________

Property owner(s):__________________________________________________________________________

Address: _________________________________________________________________________________

APPLICANT:_____________________________________________________________________________

                                                Name                                  Address                                              Phone #

I have read the Article VII of the County Code concerning Flood Damage Prevention. I certify that this application and the information attached is true and accurate to the best of my knowledge and belief.

                    ____________________________________________ Date:_______________________

                                            Signature of Applicant

DEFINITION OF TERMS USED ON THIS APPLICATION:

Floodplain: is the area of special flood hazard because it is subject to a one(1) percent or greater chance of flooding in any given year.

Floodway: means the channel of a river or other watercourse and the adjacent land areas that must be reserved in order to discharge the base flood without cumulatively increasing the water surface elevation more than a designated height.

FIRM: is the Flood Insurance Rate Map

DEVELOPMENT DESCRIPTION: Indicate the type of development you are proposing:

____Building, placing, or improving a structure

The term, "structure" refers to walled and roofed buildings, including a gas or liquid storage tanks or mobile homes. The term, "improving" refers to remodeling or repairs that exceed 50% of the market value of the building or the construction of an addition.

*Attach a plan , drawn to scale, indicating the location of the floodplain and floodway, the property lines, the footprint of the structure on the site, and the location and elevation of utility hook-ups (air conditioning units, water lines, electricity, etc.)

____Moving earth or constructing a facility

Earth-moving operations include the following activities: excavation, filling, mining, dredging, land clearing, grading, stream or river relocations, and other similar activities. This category also covers the construction of roads, water lines, dams, and other facilities that are not considered, "structures".

* Attach a plan of the site, drawn to scale, indicating the location of the floodplain and floodway , property lines, the areas to be cleared, cut, and/or filled, the amount of cut and/or fill, and the location of proposed structures or facilities, if any.

____Developing a subdivision

The term, "subdivision" refers to any division of a parcel of land that is 5 acres or larger in size. If one or more of the proposed lots are in the floodplain (and they offer no other alternative for building on the lot), the subdivision must be permitted.

* Attach a plan, drawn to scale, indicating the location of the floodplain and floodway, the existing property lines, the size and shape of the proposed lots, the location of adjoining roads, and other existing / proposed facilities.

Briefly describe the development:

REQUIRED PERMITS , APPROVALS, AND CERTIFICATIONS:

Check the permits, approvals, and certifications listed below that you must obtain for the type of development you are proposing. Indicate the date the permit, approval or certification was issued, and the issuing individual or agency. If you do not know which of the following apply to you, the Planning Office can provide assistance. Final approval of this permit application cannot be given until the applicable permits, approvals, and certifications have been secured.

Date Approved / Certified Individual/entity issuing approval/certification

___1. Base Flood Elevation Determination___________________          ___________________________Engineer

(Required for subdivisions that are greater than 50 lots or 5 acres involving Zone A on the FIRM.)

____2. Conditional No Rise Certificate ___________________          _____________________________Engineer

Final No Rise Certificate ______________________________          _____________________________Engineer

(Both are required if you are developing in a designated floodway. The certificate is available from the Planning Office)

____3. Conditional No More Than One Foot Rise Certificate_______________  ____________________Engineer

Final No More Than One Foot Rise Certificate________________         ___________________________Engineer

(Both are required if you are developing in Zone A1-30 and AE on the FIRM with no designated floodway. The certificate is available from the Planning Office.)

____4. Conditional Elevation Certificate ___________________     ______________________________Surveyor

Final Elevation Certificate ___________________                            ______________________________Surveyor

(Both are required if you are building or making improvements to a residential structure in the floodplain, or a non-residential structure that is not going to be flood-proofed. The certificate is available from the Planning Office.)

____5. Conditional Floodproofing Certificate___________________     ___________________________Engineer

Final Floodproofing Certificate ____________________                         ___________________________Engineer

(Both are required if you are building a non-residential structure in a floodplain, unless you are planning to build the lowest floor of the structure above the base flood elevation. The certificate is available from the Planning Office.)

____6. Conditional Letter of Map Revision ____________________ _____________________________FEMA

Final Letter of Map Revision __________________________            _____________________________FEMA

(Both are required to elevate a parcel of land or structure above the base flood elevation by fill, or if an engineering study was done to; 1) set the base flood elevation, or 2) certify no more than one foot rise in the base flood elevation.. Instructions and an application form for a Letter of Map Revision is available from the Planning Office.)

____7. City development approval ___________________ _________________________________

(Required if you are subdividing property outside the city limits, but within the city planning area.)

____8. County development approval ____________________ ______________________________

(Required if you are subdividing or developing outside the city limits - not including farm or single-family residential structures.)

____9. Health Dept septic approval ___________________ _________________________________

(Required if you are building a structure, or developing a subdivision. Contact the Health Department for an application.)

____10. Corps of Engineers Sec. 404 permit____________________ _________________________

(Required if you are filling in wetlands. Contact the Corps of Engineers for a permit application.)

____11. Corps of Engineers Sec. 10 permit ___________________ ___________________________

(Required if you are developing in navigable waterway. Contact the Corps of Engineers for a permit application.)

____12. PC&E Sec. 402 Stormwater permit____________________ __________________________

(Required if you are developing a parcel of land 5 acres or larger. Contact Arkansas Pollution Control & Ecology for a permit application.)

____13. PC&E Sec. 401 Water Quality permit__________________ __________________________

(Required if you are discharging into a waterway. Contact Arkansas Pollution Control & Ecology for a permit application.)

FLOOD INSURANCE RATE MAP (FIRM) AND BASE FLOOD ELEVATION (BFE) INFORMATION

FIRM # Effective Date

1. Identify the FIRM # (s) being referenced and their date(s): ______________ ____________________

                                                                                            ______________ ____________________

                                                                                            ______________ ____________________

2. What is the estimated base flood elevation on the site?___________________

3. How was the base flood elevation determined?

____From the FIRM

____By the Floodplain Administrator (attach a description of how the determination was made.)

____By an Engineer (attach technical information used to make the determination.)

4. Is the development in a floodway? ____no

                                                         ____yes

                                                         ____uncertain (no floodway is designated on the FIRM)

APPROVALS BY FLOODPLAIN ADMINISTRATOR:

Conditional Permit (Issued prior to development and construction.):

____Approved ____Disapproved

Signature of Floodplain Administrator:__________________________________ Date:____________

Final Permit (Issued following inspection):

____Approved ____Disapproved

Signature of Floodplain Administrator:__________________________________ Date:____________