FLOODPLAIN ADMINISTRATOR

________, Texas _____
DEVELOPMENT PERMIT APPLICATION
$_______PERMIT FEE
STATE OF TEXAS	§
COUNTY OF ________	§
APPLICATION NUMBER                          	§

1. NAME OF APPLICANT:                                                                                                                           
    MAILING ADDRESS:                                                                                           

2.	LOCATION OF PROPERTY (complete as appropriate)
If located in a subdivision:
	                                                                                                                                                             
	Name of Subdivision             Section No.            Block No.             Lot No.

	If NOT located in subdivision:
	                                                                                                                                                                 
	Name and No. of Survey/Abstract				Acreage
	Location Description (Attach a vicinity map)

3.	NATURE OF PROPOSED DEVELOPMENT (check and complete all that apply)

		(  ) Residential	 (  ) Placement of Fill   (  ) Other

                          (  ) Alteration of a Natural Waterway or Drainage Course

              	(  ) Non-Residential                  Name and Type of Business  ________________________________________ 

                          ( ) New Construction   ( ) Substantial Improvement to Existing Structure
                                                                                                   
WARNING:	Please read and acknowledge.
The flood hazard boundary maps and other flood data used by the __________________ Floodplain Administrator in evaluating flood hazards to proposed developments are considered reasonable and accurate for regulatory purposes and are based on the best available scientific and engineering data.  On rare occasions greater floods can and will occur and flood heights may be increased by man-made or natural causes.  Issuance of an exemption certificate does not imply that developments outside the identified areas of special flood hazard will be free from flooding or flood damage.  Issuance of an exemption certificate shall not create Liability on the part of ________________, the________________ Floodplain Administrator or any officer or employee of ________________ in the event flooding or flood damage does occur.  

Additional federal, state or local, permits may be required. 
		
                                                                                  Signature______________________________                    Date:  _______________                                                                                         

4.  APPLICANT WILL PROVIDE ONE COPY OF PLANS AND SPECIFICATIONS OF THE PROPOSED CONSTRUCTION, IF IN A FLOOD PLAIN.
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FOR USE BY FLOODPLAIN ADMINISTRATOR
Is the property located in an identified flood hazard area?	( )Yes     ( )No
Is the property located in the floodway?	( )Yes     ( )No
FIRM Zone Designation is: _______  FIRM Panel No. ____________  Dated ____________
Base Flood Elevation at the site is _______ft NGVD (MSL) or is unavailable ____________
Is additional information required (including Letter of Map Change)?	( )Yes     ( )No
Ensure that applicant is receiving the necessary federal, state, or local permits.  	( )Yes     ( )No
 (  ) Variance Issued
 (  ) Permit Application Approved

 (  ) Permit Application Denied
                                                                      
                                         Floodplain Administrator______________________________                    Date:  _______________                                                                                         

THIS PERMIT IS VALID FOR ONE YEAR FROM DATE ISSUED AND WILL NEED 
TO BE RENEWED IF WORK IS NOT COMPLETED AT THAT TIME