Local Floodplain Development Permit Application

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Owner/Agent Name *

Owner Mailing Address, City, State, Zip *

Owner Phone Number & Email address *

Project Street Address or Parcel ID #, City, State, Zip *

Type of Development *

New Construction

Improvement/Addition to existing structure

Excavation

Grading

Filling

Other:

Development Description *

Size of Site/Lot (Ft x Ft) *

Estimated Cost of project *

Principal use of building *

Accessory Uses: (Storage/Parking, etc.) *

Addition or modification to non-conforming use *

Yes

Unknown if it is a non-conforming use

Assessed value of structure before improvement/new building *

Elevation Datum used from Iowa DNR Floodplain Development Permit *

NAVD88

NGVD29

Other

Elevation of the 100 year (Base) Flood (Ft): *

Source of the Elevation of the 100 year (Base) Flood Ft *

Elevation of the proposed development site (natural ground) ft *

Required elevation/flood proofing for lowest floor (ft): *Should be a minimum of 1 ft above the Base Flood 100 Year Elevation (BFE). *

Proposed elevation/flood proofing level for lowest floor (including basement): *

Other information:

THIS PERMIT IS ISSUED WITH THE CONDITION THAT THE LOWEST FLOOR INCLUDING BASEMENT OF ANY NEW OR SUBSTANTIALLY IMPROVED RESIDENTIAL OR NON-RESIDENTIAL BUILDING WILL BE ELEVATED AT LEASE 1.0 FOOT ABOVE THE 100 YR. BASE FLOOD ELEVATION.

Other permits required? Please Check which permits your Joint Application through the Iowa DNR require. This can be answered once you receive your two letters form the joint application. *

Iowa DNR Floodplain Permit

IDNR Sovereign Lands Permit

US Army Corps of Engineers

ESA Compliance Clearance

Other

The Joint Application responded with no permit required

Required

All provisions of the City/County of Welton, Clinton County, Iowa, Flood plain management ordinance Chapter 14 shall be complied with. *

Yes

This permit is issued with the condition that the developer/owner agrees to provide certification by a registered engineer, architect, or land surveyor of the "as-built" lowest floor including basement elevation of any new or substantially improved building covered by this permit *

Yes

Electronic submission of this permit constitutes your signature and agreement to the permit terms. Please type your full legal name below. *

Today's Date *

YYYY

This space is for the signature of the Authorizing Official of the City of Welton __________________________ Date _____/_____/_____

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