SPECIAL FLOOD HAZARD AREA DEVELOPMENT PERMIT APPLICATION

Application is hereby made for a DEVELOPMENT PERMIT as required by the Flood Damage Prevention Resolution of Fairfield County for development in an identified flood hazard area. The undersigned agrees that all activities shall be completed in accordance with the requirements of said Resolution. The development to be performed is described below and in attachments hereto.

Applicant understands and agrees

this permit is issued on the conditions and facts described;
any permit may be repealed if conditions or facts change;
permit void if the activity has not begun within 180 days of the issuance date;
the permit will remain valid for one year from date of issuance;
elevation certification form must be finished and returned at time activity is completed.

Owner’s Name:

Address:

Phone:

Builder:

Address:

Phone:

NOTE: In addition to completion of this form the applicant agrees to submit any additional information required by the administrator in order to determine that the proposed development is compliant with the local and federal flood damage prevention criteria of the National Flood Insurance Program.

Additional information may include but is not limited to: site specific plans to scale showing the nature, location, dimensions, and elevations of the area and structure(s) in question.

DESCRIPTION OF WORK

1. Location of proposed development site – address:

Legal description:

2. Type of development proposed: (Please mark the area(s) which best describes the type of activity proposed)

NEW BUILDING residential nonresidential manufactured home installation

EXISTING STRUCTURE alteration vertical addition horizontal addition accessory materials storage

SITE WORK filling/grading mining/dredging watercourse alteration other*

*Describe activity:

3. If the proposed construction is an alteration, addition or improvement to an existing structure:

Cost of proposed construction: $

What is the estimated market value of existing structure: $

NOTE: An existing structure must comply with the flood protection standards if it is substantially improved (an improvement equal to or greater than 50% of the market value of the structure). FEMA maintains that the “substantial improvement” definition applies to exiting structures only and that once a structure meets the definition of “new construction” any further improvements to that structure must meet “new construction” requirements. For floodplain management purposes “new construction” means structures for which “start of construction” began on or after the effective date of the initial Flood Insurance Rate Map issued by FEMA for Fairfield County (April 17, 1989).

4. Does the proposed development involve a subdivision or other development containing at least 50 lots or 5 acres

Subdivision or other development containing at least 50 lots or 5 acres Yes: No:

NOTE: If yes, base flood elevation data is required from applicant if it has not been provided by FEMA.

I AGREE THAT ALL STATEMENTS IN AND ATTACHMENTS TO THIS APPLICATION ARE A TRUE DESCRIPTION OF THE EXISTING PROPERTY AND THE PROPOSED DEVELOPMENT ACTIVITY. I UNDERSTAND THE DEVELOPMENT REQUIREMENTS FOR SPECIAL FLOOD HAZARD AREA ACTIVITIES PER THE APPROPRIATE RESOLUTION AND AGREE TO ABIDE THERETO. I UNDERSTAND IT IS MY RESPONSIBILITY TO OBTAIN ALL APPLICABLE FEDERAL, STATE, AND LOCAL PERMITS.

Date:

Applicant’s Signature:

ADMINISTRATION

NOTE: The following is to be completed by the local floodplain administrator. All references to elevations are in feet mean sea level (m.s.l.). The term base flood means the same as the 100-year elevation.

5. Base Flood Elevation (100-year) at proposed site feet m.s.l.

Data Source:

Map Effective Date:

FEMA Community Panel Number:

6. Does the structure contain: basement enclosed area used only for parking access or storage, other than basement, below the lowest floor level?

7. Is the proposed development located in: an identified floodway a flood hazard area where base flood elevations exist with no identified floodway an area within the floodplain fringe an approximate flood hazard area (Zone A). If yes, complete only 8a in the following question.

NOTE: Floodway development must demonstrate through hydrologic and hydraulic analysis, performed in accordance with standard engineering practice, that no increase in base flood elevation will result during occurrence of the base flood discharge. If base flood elevations exist with no floodway delineation, hydrologic and hydraulic analysis is required to demonstrate not more than one foot increase at any point to the water surface elevation of a base flood.

8a. Does proposed development meet NFIP and local general standards at section 5.1 of your regulations?

General standards Construction materials and methods resistant to flood damage. Anchored properly. Utilities safe from flooding. Subdivision designed to minimize flood damage.

8b. Does proposed development meet NFIP and local specific standards at section 5.2 of the Special Purpose Flood Damage Prevention Regulations.

Specific standards Encroachments – proposed action will not obstruct flood waters.

Proposed site grade elevation of fill or topographic alteration. Top of fill or elevation to be at m.s.l.

Proposed lowest floor elevation (including basement) to be at m.s.l.

Proposed floodproofed elevation to be at m.s.l.

NOTE: All residential structures must be built with the lowest floor, including basement, elevated or floodproofed to an elevation of 1 foot or more above the base flood elevation (100-year) unless a variance has been granted. Only nonresidential structures may be floodproofed.

9. For structures located in approximate Zone A (no BFE available) the structure’s lowest floor is

feet above the highest grade adjacent to the structure.

10. Filling Fee: $ 75.00

Date Paid:

Cash

Check No.:

11. The proposed development is in compliance with the Special Purpose Flood Damage Prevention Regulations.

PERMIT ISSUED ON:

PERMIT NUMBER:

12. PERMIT DENIED:

13. SECTION 4.3 EXEMPTION:

Date:

Administrator’s Signature: