WOODFORD COUNTY BUILDING & ZONING DEPARTMENT FLOODPLAIN DEVELOPMENT PERMIT APPLICATION FORM OWNERS NAME & ADDRESS: PHONE #:

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1 WOODFORD COUNTY BUILDING & ZONING DEPARTMENT FLOODPLAIN DEVELOPMENT PERMIT APPLICATION FORM The undersigned hereby makes application for a floodplain development permit as required under Section 5 of the Woodford County Floodplain Ordinance for development as defined in said ordinance; the work to be performed is described below and in attachments hereto. The undersigned agrees with the requirements set forth in the Woodford County Floodplain Ordinance and with all other applicable local, state and federal regulations. This application does not create liability on the part of the County of Woodford or any officer or employee thereof for any flood damage that results from reliance on this application, or action taken pursuant to the floodplain development permit or any administrative decision made lawfully thereunder. DATE:_ TAX ID# OWNERS NAME & ADDRESS: _ PHONE #: APPLICANT S NAME & ADDRESS: PHONE # : CONTRACTOR S NAME & ADDRESS: PHONE # : LEGAL DESCRIPTION TOWNSHIP SUBDIVISION _ LOT _ BLOCK PARCEL ADDRESS: ACREAGE _ IS THE PROPOSED SITE IN THE: (CHECK ONE) DESIGNATED FLOODWAY DESIGNATED FLOODPLAIN NOTE: If the proposed development is located in a floodway enter the IDOT/DWR permit # and date issued. PERMIT # _ DATE ISSUED TYPE OF PROPOSED DEVELOPMENT: Explain in detail the exact proposed development taking place on the property. Include area to be developed, amounts and types of materials to be used for fill, levees, paving, mining, excavating, dredging, etc.

2 DEVELOPMENT IS: CONSTRUCTION OF NEW PRINCIPAL STRUCTURE CONSTRUCTION OF NEW ACCESSORY STRUCTURE IMPROVEMENT TO EXISTING STRUCTURE MOBILE HOME OR MANUFACTURED HOME FILLING, DREDGING, GRADING, EXCAVATING, ETC. STORAGE OF MATERIALS, INCLUDING LP TANKS, ETC. FLOODPLAIN AREA OR AFFECTED TRIBUTARY: ILLINOIS RIVER MACKINAW RIVER PARTRIDGE CREEK PANTHER CREEK OTHER FIRM FLOOD ZONE PANEL # BASE FLOOD ELEVATION (BFE): FLOOD PROTECTED HEIGHT: _ (2 FEET ABOVE BFE)

3 COMPLETE FOR ALTERATIONS, ADDITIONS OR IMPROVEMENTS TO EXISTING STRUCTURES ONLY: ESTIMATED MARKET VALUE OF EXISTING STRUCTURE PER APPLICANT $ ASSESSED VALUE PER PROPERTY RECORD CARD_ X 3 = $ COST OF PROPOSED CONSTRUCTION (Must include attached detail sheet) $ COMPLETE FOR NON-RESIDENTIAL FLOODPROOFED CONSTRUCTION ONLY: TYPE OF FLOODPROOFING METHOD IF THE STRUCTURE IS FLOODPROOFED, THE REQUIRED FLOODPROOFING ELEVATION IS FEET, MEAN SEA LEVEL. CERTIFICATION BY REGISTERED PROFESSIONAL ENGINEER OR ARCHITECT ATTACHED? _YES NO Attach site plan in accordance with the following requirements: The site plan should be drawn to scale and must include: -- all structures on the property; -- property line dimensions; -- existing grade elevations; -- all changes in grade resulting from proposed excavation or filling; --the location and dimensions of all existing and proposed buildings and/or additions. --For all proposed buildings, the elevation of the lowest floor (including basement, cellar or crawl space) and the lowest adjacent grade shall be shown. THE APPLICANT UNDERSTANDS THAT: --THE PERMIT APPLIED FOR, IF GRANTED, IS ISSUED ON THE REPRESENTATIONS MADE HEREIN; --THAT ANY PERMIT ISSUED MAY BE REVOKED BECAUSE OF ANY BREACH OF REPRESENTATION; --THAT ONCE A PERMIT IS REVOKED ALL WORK SHALL CEASE UNTIL THE PERMIT IS REISSUED OR A NEW PERMIT IS ISSUED; --ANY PERMIT ISSUED ON THIS APPLICATION WILL NOT GRANT ANY RIGHT OR PRIVILEGE TO ERECT ANY STRUCTURE OR USE ANY PREMISES DESCRIBED FOR ANY PURPOSE OR IN ANY MANNER PROHIBITED BY THE ORDINANCES, CODES, OR REGULATIONS OF WOODFORD COUNTY; --THE APPLICANT HEREBY GIVES CONSENT TO THE ZONING ADMINISTRATOR OR HIS REPRESENTATIVE TO MAKE REASONABLE INSPECTIONS TO ENFORCE THE PROVISIONS OF THE WOODFORD COUNTY FLOODPLAIN AND/OR ZONING ORDINANCE WITHOUT FIRST OBTAINING A SEARCH WARRANT; --UPON ISSUANCE, THE PERMIT POSTING CARD WILL BE POSTED IN A CONSPICUOUS PLACE ON THE PREMISES, IN PLAIN VIEW AND;

4 --UPON ISSUANCE, THE PERMIT WILL EXPIRE IF NO WORK IS COMMENCED WITHIN 90 DAYS OF ISSUANCE. I HEREBY CERTIFY THAT ALL THE STATEMENTS IN AND ATTACHMENTS TO THIS APPLICATION ARE A TRUE AND ACCURATE DESCRIPTION OF THE EXISTING PROPERTY AND THE PROPOSED DEVELOPMENT. APPLICANT SIGNATURE DATE CONSTRUCTION SUMMARY EXTERIOR A) WOOD FRAME: PLYWOOD/HARDBOARD STUCCO SIDING ALUMINUM VINYL SHINGLES MASONRY/VENEER B) MASONRY: BRICK CONCRETE BLOCK OTHER DESCRIBE C) SIZE: 1 STORY 1-1/2 STORY 2 STORY BI-LEVEL TRI-LEVEL 3 OR MORE D) GARAGE: ATTACHED CARPORT: ATTACHED DETACHED DETACHED E) FOUNDATION: SLAB-ON-GRADE BASEMENT CRAWL SPACE F) BASEMENT: FINISHED UNFINISHED INTERIOR A) WALLS: DRYWALL PLASTER PANELING OTHER DESCRIBE

5 B) FLOORS: HARDWOOD CARPETING TILE LINOLEUM OTHER DESCRIBE ESTIMATED COST OF CONSTRUCTION OWNER: CONTRACTOR: NAME ADDRESS PHONE SIGNATURE FOR OFFICIAL USE THESE 2 COLUMNS ITEMS OR MATERIALS LABOR MATERIALS LABOR MATERIALS FOUNDATION WALLS ROOF FLOORING PLUMBING ELECTRICAL FURNACE/HVAC EQUIPMENT INSULATION EXTERIOR WALL FINISH (I.E. VINYL/ALUMINUM SIDING, BRICK) INTERIOR WALL FINISH (I.E. DRYWALL/PLASTER) FIXTURES (ATTACHED APPARATUS) CABINETS (BUILT-IN-ONLY) INTERIOR FINISH CARPENTRY DECORATIVE FINISHES (I.E. PANELING, ETC.) PAINT LIGHT FIXTURES & CEILING FANS ATTACHED (ITEMS SUBTOTAL) TOTAL TOTAL LABOR & MATERIALS: $ $ _

6 FOR OFFICIAL USE Improved Value$ (FOR OFFICIAL USE) ITEMS THAT CAN BE EXCLUDED FROM THE ESTIMATED COST OF CONSTRUCTION: * PLANS, SPECIFICATIONS, SURVEY AND BUILDING PERMITS * COSTS ASSOCIATED WITH SITE PREPARATION AND DEBRIS REMOVAL * STRUCTURAL FILL FOR ELEVATING THE BUILDING * PLUG-IN APPLIANCES SUCH AS WASHERS, DRYERS, STOVES, REFRIGERATORS, WINDOW AIR-CONDITIONING UNITS, OR DE-HUMIDIFIERS * FENCES, SIDEWALKS, AND YARD LIGHTS ADMINISTRATIVE USE ONLY 1. PERMIT FEE $_ PAID DATE_ 2. PERMIT # ISSUED DATE 3. WORK INSPECTED BY DATE 4. AS BUILT ELEVATION CERTIFICATE ATTACHED? 5. PERMIT DENIED BY DATE _ 6. LOCAL FLOODPLAIN ADMINISTRATOR_ Signature _ Date