Fillable FPR Please submit FPR applications to the Teton (Teton County Wyoming Government)

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FPR Please submit FPR applications to the Teton (Teton County Wyoming Government)

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FPR Permit Application
1
Effective 07/01/2020
FLOODPLAIN PERMIT REVIEW (FPR) APPLICATION
Engineering Department
Please check all that apply:
320 S. King St.
Phone : (307) 733-3317
P.O. Box 3594
www.tetoncountywy.gov
Small-Scale Project ($600)
Large-Scale Project ($900)
Jackson, WY 83001
For guidance: FPR Fee Schedule
PIDN:
Name:
(must agree with Deed)
Phone:
Mailing Address:
City, State:
Email:
ZIP:
Additional Property Owners*:
*Attach additional forms if there are multiple landowners. This application will not be approved without the signature of all landowners (or their authorized agents).
Name:
Phone:
Mailing Address:
City, State:
Email:
ZIP:
Type of Project:
New
Existing
Quantity of Fill placement in Floodplain:
Cubic Yards (Note: calculations must be provided)
Brief Description:
For Office Use Only
GEC
BDR SWF BRG
SITE LOCATION: (List all properties effected, if not enough room please attach list.)
Please submit FPR applications to the Teton County Engineering Department at 320 S. King St.
Please type or fill out this application, completely.
OWNER: A copy of the Warranty Deed(s) or Contract of Sale must accompany this application.
APPLICANT/AGENT: If the applicant is other than owner, a notarized Teton County Planning & Development Letter of Authorization must accompany this
application. Only the owner or his/her authorized agent may sign the application, correction list or
per
mit.
BRIEF PROJECT DESCRIPTION AND PURPOSE:
FPR
FPR Permit Application
2
Effective 07/01/2020
ACTIVITY TYPE
CATEGORIES
COMPONENTS
New Construction
Residential Structure
Excavation
Addition
Non-Residential Structure
Fill
Alteration
Manufactured/Mobile Home
Channelization
Relocation
Bridge/Culvert
Grading
Demolition
Levee
Clearing
Replacement
Road/Utility
Mining & Dredging
Rehabilitation
Stream Bank/Channel
Drilling
Floodplain Map Revision Application (LOMR)
Irrigation Structure
Debris Removal
SPECIAL CONDITIONS
Habitat Enhancement
Wetland Impact
*Emergency After-the-Fact Application
Water & Sewer/Septic Systems
*Emergency activities must be authorized by the Floodplain
Administrator prior to beginning work.
Subdivision (new or expansion)
REQ.
N/A
PERMIT
ISSUED/WAIVED/PENDING
USACE 404
USACE 408
DEQ Turbidity Waiver
USFS Section 7
Other:
Watercourse Name(s):
Flood Insurance Rate Map (FIRM) Panel No:
Map Date:
Additional FIRMs:
Special Flood Hazard Zone(s):
Is the Project in the Floodway?
Yes
No
Have BFEs/100-year Water Surface Elevations been determined?
Yes
No
If yes, Base Flood Elevation (BFE) at Project Site:
Downstream Lettered X-section:
Upstream Lettered X-section:
If no, what is the LOCATION of the highest adjacent grade (HAG) to the structure?
Elevation of the highest adjacent grade?
For Residential and Non-Residential structures, proposed Lowest Floor Elev.:
Proposed Floodproofing Elev. (if applicable):
PROJECT INFORMATION: (check all that apply)
OTHER AGENCY PERMITS: List all applicable local, state and federal permits. (Copies of each permit must be provided before issuance of the FPR)
FLOOD HAZARD DATA:
FPR Permit Application
3
Effective 07/01/2020
Mark all that apply to the proposed development project:
Elevation Certificate: Required to document the lowest floor of all new and substantially improved post-FIRM structures in
the floodplain.
As-built Elevation Certificate must be submitted to County Floodplain Administrator prior to issuance of Certificate of
Occupancy. Must be completed by a registered Professional Engineer or Land Surveyor. (NOTE: Inspections may be required
during & after construction)
Non-Residential Floodproofed Structure: Floodproofing Certificate completed by a registered Professional Engineer or
Architect (required with permit application).
Enclosure or Crawlspace below the Structures Lowest Floor: Openings must meet Floodplain Management Resolution criteria
or be designed by a registered Professional Engineer or Architect.
Floodway Encroachment: No-Rise Certification completed by a registered Professional Engineer (must provide written No-Rise
certification along with supporting documentation, technical data and hydraulic model files).
Water/Sewer/Septic System Compliance: Certification that these systems have been designed and located to avoid
impairment to them or contamination from them during flooding.
Floodplain Study: New/expanded Subdivision; Approx. Zone A Areas; bridges & structures; flood map revisions, or other. A
registered Professional Engineer must submit a written report and hydraulic model files.
Watercourse Alteration: Realignment or diversion; Certification from a qualified engineer or professional with floodplain
experience that the flood-carrying capacity will be maintained.
Variance Request: Include detailed letter describing the reasons and conditions of the request ($750). Refer to Floodplain
Management Resolution for requirements.
Signature of Applicant Date
Print Name Title
For Office Use
Only
Planning Sufficiency declared by: Date:
Planning Review conducted by : Date:
A fee due at the time of submittal – Floodplain Development Fee Schedule
Letter of Authorization if the applicant is other than the property owner.
A copy of the Warranty Deed.
One plan set of legible complete design drawings scaled on 11” x 17” paper.
One PDF set of design drawings and FPR application with all attachments emailed to permits@tetoncountywy.gov (no larger than 25MB).
Questions about FPR Permit Applications, design plans and any supporting documents should be directed to the Engineering
Department (307-733-3317).
ACCOMPANYING PERMIT APPLICATION CERTIFICATIONS, COMPLIANCES, & REQUESTS: Include all that apply with permit submittal.
I certify that I have read and examined this application and know the same to be true and correct. All provisions of the laws and
ordinances governing this work will be complied with whether specified herein or not. The granting of this permit does not give
authority to violate or cancel the provisions of any state or local law regulating grading or the performance thereof.
SUBMITTAL REQUIREMENTS:
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FPR Please submit FPR applications to the Teton (Teton County Wyoming Government)

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Completed 14 February 2021

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