BASTROP COUNTY DEVELOPMENT SERVICES APPLICATION
211 Jackson Street, Bastrop, Texas 78602 512 / 581-7176 512 / 581-7178 (fax) website: www.co.bastrop.tx.us
PRINT CLEARLY AND COMPLETE ALL QUESTIONS. ENTER “N/A” IF ITEM DOES NOT APPLY. DO NOT LEAVE ANY ITEM BLANK.
APPLICATION TYPE –Select all that apply.
Development/Construction Driveway/Right-of-Way On-Site Sewage Facility 9-1-1 Address
REQUIRED DOCUMENTS –Application must include items shown below. An incomplete/illegible application will delay process and may be returned.
Proof of Ownership
Site Plan
Copy of Survey or Plat
Other Required Permits
On-Site Sewage Facility Must Include:
Septic Plan/Specifications
Site Evaluation Report
Aerobic OSSF Only Must Include:
Affidavit for Maintenance
Maintenance Contract
PROPERTY OWNER INFORMATION –Enter property owner information only; do not enter builder or agent information.
Name(s) Shown on Deed:
Mailing Address: Apt/Unit/Ste #:
City: State: Zip:
Daytime Phone #: Email:
PROPERTY DESCRIPTION –Refer to Bastrop Central Appraisal District on-line property records at www.bastropcad.org or call 512-303-1930.
Property ID Number(s): R Number of Acres:
Legal Description(s):
Does this property comply with local subdivision plat requirements or meet an exception to the plat requirements? Yes No
ENDANGERED SPECIES ACT –Refer to the Bastrop County Lost Pines Habitat Conservation Plan Area map.
Is the property located in the Lost Pines Habitat Conservation Plan (LPHCP) area (e.g.: Houston toad habitat)? Yes No
If yes, do you agree to participate in the LPHCP for incidental take authorization of the endangered Houston toad? Yes
No
FLOODPLAIN/FLOODWAY –Refer to FEMA flood map at www.msc.fema.gov or submit Flood Determination request to vickie.box@co.bastrop.tx.us.
Is any part of the property within the Federal Emergency Management Agency (FEMA) 100-year floodplain? Yes No
DEVELOPMENT INFORMATION –Provide the following information for each existing and proposed structure. Use additional sheets if necessary.
List each existing building and indicate if it will be demolished/removed and date:
Enter the number of new/proposed structures: Provide the following information for each new/proposed structure:
Classification: Single Family Residential Main Guest/Secondary Duplex Accessory Building
Non Single-Family Residential Multi-Family Single-Unit Commercial Multi-Unit Commercial
Construction: Site-Built Mobile/Pre-manufactured RV/Travel Trailer Other:
Foundation: Slab Pier and Beam Basement Other:
Dimensions: Total Square Footage: Occupied Square Footage (heat/cool):
Number of: Floors/Subfloors: Apts/Stes: Bedrooms: Bathrooms: Kitchens:
Contractor:
Daytime Phone #: Email:
ON-SITE SEWAGE FACILITY
Designer’s Name: Phone: License #:
Maintenance Provider: Phone: License #:
Installer’s Name: Phone: License #:
Installation Type: Standard Design Professional Design Modification Tank Replacement
System Type: Brand:
Water Source: Private Water Well Public Water System: Name:
ACKNOWLEDGEMENT –Read and acknowledge
I certify that all information, statements and documents provided are true and correct to the best of my knowledge. I understand that permit(s) may be revoked by
Bastrop County, its duly appointed agents, representatives and staff (“the County”) at their discretion. Should development/plans be altered, I agree to submit a revised
application, pay any additional fees, and immediately cease development until further notice by the County. I acknowledge that the submittal of this application and any
subsequent permit(s)/correspondence(s) does not create liability on the part of the County; in addition I agree to hold the County harmless against any actions for
resulting personal injury or property damage. I hereby grant the County access to the identified property for site, development, and compliance inspections.
Signature: Date:
Print Name: Owner Owner’s Agent (Owner’s written approval required.)
DEVELOPMENT APPLICATION-REV. 20141001 PAGE 1 OF 1
OFFICIAL USE ONLY
File #:
Rec’d:
one
__________________________
____________________________________________________
click to sign
signature
click to edit
![]()
