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Floodplain Development Permit – Application 1 Revised: October 2021 Floodplain Development Permit Application 101 N. 4th Street / P. O. Box 1030 Douglas, Wyoming 82633 [PHONE REDACTED], Fax: [PHONE REDACTED] Date: Project Address: Owner: Email: Address: Telephone: Contractor: Email: Address: Telephone: Additional Project Directions: Project Description Single Family Residential New Construction Channelization Multi-Family Residential Substantial Improvement >50% Fill Manufactured (mobile) Home Improvement <50% Bridge/Culvert Non-Residential Rehabilitation Levee Other/Explanations: Attach detailed site development plans showing the floodplain. Signature Date SIGN ---PAGE BREAK--- Floodplain Development Permit – Application 2 Revised: October 2021 Community Development Department Use Only Flood Hazard Data Watercourse Name: The project is proposed in the Floodway: The project is proposed in the Floodway Fringe: Floodway Zone: X A AE Base (100-year) flood elevation(s) at project site (BFE): Elevation required for Lowest Floor: NGVD Elevation required for Floodproofing: NGVD Source Document: Reports/Maps: Proposal Review Checklist Site development plans are complete & depict flood hazard data. Engineering data is provided for proposed map & floodway revisions. Floodway certificate & data documents no increases in flood heights. Subdivision proposals minimize flood damage & protect utilities. Lowest floor elevations are above the base (100-year) flood level. Manufactured (mobile) homes address elevation & anchoring requirements. A Floodproofing Certificate certifies floodproofing designs. Other: Permit Action Permit Approved: The information submitted for the proposed project was reviewed and is in compliance with approved floodplain management standards (site development plans are on file). Permit Denied: The proposed project does not meet approved floodplain management standards (explanation is on file). Variance Granted: A variance was granted from the base (100-year) flood elevations established by FEMA consistent with variance requirements of NFIP regulations Part 60.6 (variance action documentation is on file). Permit Conditions: Compliance Documentation Map Revision Data. Certified documentation by a registered professional engineer of as-built conditions for floodplain alterations were received & submitted to FEMA for a flood insurance map revision. Fill Certificate. A community official certified the elevation, compaction, slope & slope protection for all fill placed in the floodplain consistent with NFIP regulations Part 65.5 for map revisions. Elevation & Floodproofing Certificates. The as-built elevation of the building’s lowest floor was certified as NGVD; or the building’s floodproofing level was certified as NGVD; by a registered professional engineer or licensed surveyor & is on file. Certificate of Occupancy or Compliance Issued on (date) Building Permit Number: Floodplain Administrator’s Signature Date SIGN