2. Name*
3. Permit #*
5. Phone Number*
6. Email Address*
8. Address*
10. City*
11. Zip Code*
15. Location of Property (complete as appropriate):
17. Property Address*
19. Name of Subdivision*
21. City*
22. Zip Code*
24. Phase*
25. Block #*
26. Lot #*
30. If NOT located in a subdivision
32. Abstract/Property I.D. Number:*
34. Latitude in Decimal Degrees:*
35. Longitude in Decimal Degrees:*
37. NATURE OF PROPOSED CONSTRUCTION (Check and complete as appropriate)*
    -- Select One --ResidentialNon-ResidentialAlteration of a Natural Waterway or Drainage CoursePlacement of FillOther
39. If Other is selected, explain:*
41. DESCRIPTION OF PROPOSED CONSTRUCTION (Check and complete as appropriate)*
    -- Select One --Substantial Improvement to Existing StructureHouseManufactured HomeNon-ResidentialCommercialOther
43. Non-Residential, Commercial or Other is selected, please explain:*

    If Non-Residential, Commercial or Other is chosen, please explain in the comment box.

    If NOT Non-Residential, Commercial or Other, put N/A

45. Plans / Aerial View*
47. H & H Study
49. LOMR
51. Additional Attachment(s)
55. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
57. Electronic Signature*
58. Date*
    Date

62. THIS SECTION IS FOR USE BY COUNTY ADMINISTRATOR ONLY

66. Is the property located in an identified Flood Hazard Area?

    1. Yes

    1. No
68. FEMA Flood Zone Type
70. Is additional information required?

    1. Yes

    1. No
72. Are other Local permits required?

    1. Yes

    1. No
74. Are other County regulations applicable?

    1. Yes

    1. No
76. Permit Application Status

    1. Approved

    1. Rejected
78. Signature of County Administrator
79. Date Signed by County Administrator
    Date Signed by County Administrator

83. If you check the box: Receive an email copy of this form. You’ll receive an e-mail from NoReplyCivicPlus.com.

Leave This Blank:


85. 1. Receive an email copy of this form.
86. Email address

    This field is not part of the form submission.

87. Submit

* indicates a required field