Building Permit #

Name as it will appear on permit:

Physical Address:

Floodplain Construction Authorization Permit #

Date:

County Limits Screen No.

Fully in Flood Partially in Flood Structure shown on the FIRM as in the SFHA

Builder:

Alternate Key:

Subdivision:

The property referenced above is located within the flood hazard area

______________________________________________Floodplain Administrator

(1) F.S.E. Building Under Construction Elevation Certif. ft. Received

Street City state Zip Code

Section: Township: Range:

Block: Lot:

Map Panel

as defined by F.I.R.M. panel numbers

as shown above. The base flood elevation for the property has been determined to be

IMPORTANT

* The finished floor, including basement must be 18 inches, or greater, above the base flood elevation (BFE). * Lowest elevation of machinery/equipment servicing building must be 18 inches above the base flood elevation. * No filling or dredging shall take place within the floodplain unless the owner receives prior written approval by The Lake County Public Works Department. (Approved filling of Floodplain is for the elevation of structures only). * Lake County LDR, Sec. 9.07.08 ( A) (3) “For legally created Lots or parcels of land . . . Where buildable area exists out of the Flood-prone area, Development Shall take place in that area". . . . "

All applicable County, State and Federal permits shall be obtained before commencement of the permitted development. The applicant hereby certifies that the above information is correct, has provided a boundary survey dated and signed/sealed by a Florida Registered Professional Land Surveyor; including floodplain location, base flood elevation, elevation benchmark and zone classifications per the Federal Emergency Management Agency (FEMA) and/or the Lake County Land Development Regulations; whichever imposes the most stringent restriction shall prevail. I understand no construction can proceed beyond the footer/slab until the finished floor (including basement) Elevation Certificate is received and acknowledged by the Stormwater Section of the Public Works Department.

PLEASE PRINT &: ___________________________________ SIGN _________________________________________

__________________2012

(2) F.F.E. Finished Floor Construction Elevation Certif. ft. Received __________________2012

Staff Initials: _____

Staff Initials: ______

Based on:

Non-living Structure Vented

Stormwater Section of Public Works 4th Edition - July 13 , 2009 Lake County Public Works - 437 Ardice Avenue, Eustis, FL. 32726-6573 / Revised Aug. 8, 2012

Distance from floodplain:

**As of October 1, 2007, there is an $80.00 fee charged for each Floodplain Construction Permit**

LAKE COUNTY, FLORIDA FLOODPLAIN CONSTRUCTION AUTHORIZATION PERMIT

ELEVATION CERTIFICATES REQUIRED:

If Pre-Firm (built before 4/1/82) the value of Original Structure

Substantial Improvement?

Floodplain Administrator Signature

Owner:

Floodplain Development Permit or approval pursuant to ordinance 104.5 shall become invalid unless the work authorized by such permit is commenced with 180 days after its issuance, or if the work is suspended or abandoned

for a period of 180 days after the work commences. Extensions of not more than 180 days shall be requested.

Estimated Value of Construction

Building Permit Co-ed Date___________________

Mailing Address:

Street City state Zip Code

Type of Construction:

BELOW THIS LINE TO BE COMPLETED BY STORMWATER / PUBLIC WORKS / LAKE COUNTY, FLORIDA

FLOODPLAIN

I (the above signed) understand and agree to all requirements associated with this permit.

may be issued a building permit for new construction or substantial improvement provided it is in accordance with all applicable zoning, building and floodplain regulations and includes, but is not limited to, the above.

feet (NAVD). The applicant