TOWN OF CLAYTON
Engineering & Inspections
111 E. Second St., P.O. Box 879
Clayton, NC 27528
Phone: 919-553-5002
Fax: 919-553-1720
Name of Project:
Date:
Applicant Name:
The following checklist to be completed by applicant:
[ ] Tax assessor map
[ ] Maps and/or plans showing the location, scope and extent of development
[ ] Floodproofing Certificate or flood opening requirements: Certificate and supporting documentation
[ ] No-Rise Certificate: Certificate and supporting documentation used to provide the certification
[ ] Elevation Certificate
[ ] Pre Construction
[ ] Building Under Construction
[ ] Finished Construction
[ ] Grading plans
[ ] Regulatory flood protection elevation for protection of all public utilities
[ ] Conditional Letter of Map Revision (CLOMR)
[ ] Structure valuation documentation
[ ] Copies of all federal, local, and stated permits that may be required.
Reviewed by: ______________________________________________
FLOODPLAIN DEVELOPMENT PERMIT
COVER SHEET
September 2019
Page 1 of 3
TOWN OF CLAYTON
Engineering & Inspections
111 E. Second St, P.O. Box 879,
Clayton, NC 27528
Phone: 919-553-5002
Fax: 919-553-1720
FLOODPLAIN DEVELOPMENT PERMIT
To an
y development activities located within special flood hazard areas
Application Fee:
Issued Permit:
Fees are due at time of submittal. (See Comprehensive List of Fees & Charges.)
Once a Floodplain Development Permit has been issued, all activities pursuant to such
permit shall be commenced within six months.
Expiration: A Floodplain Development Permit expires if the permitted activity is discontinued for one
(1) year or more.
APPLICANT/CONTRACTOR INFORMATION
Appli
cant: _________________________________________________________________________________
Mailing Address: ____________________________________________________________________________
Phone Number: __________________________________ Fax: __________________________________
Contact Person: ______________________________________________________________________________
Email Address: ______________________________________________________________________________
SITE INFORMATION
Dev
elopment Name: ________________________________________________ Lot #: ____________________
Address/Location: ___________________________________________________________________________
Property Owner’s Name: ______________________________________________________________________
Previous Use Description: _____________________________________________________________________
Proposed Use Description: _____________________________________________________________________
Business Name: ______________________________________________________________________________
Brief Description of Request: ___________________________________________________________________
FOR OFFICE USE
Date Received:
Amount Paid: Permit Number:
September 2019
Page 2 of 3
REQUIRED INFORMATION (to be submitted with the application)
The following items must accompany a Floodplain Development Permit application (if not applicable, check
“n/a.”)
To be completed by the applicant:
To be completed by staff:
Yes
N/A
Yes
No
N/A
1.
Permit Review Fee
2. Completed application
3. Owner’s Consent Form
Required if applicant is not the property owner.
4. A copy of a current site plan and/or survey to scale
which identifies project boundaries and lot
dimensions, acreage, structures (size and location),
along with the boundary of the special flood hazard
area as delineated on the Flood Insurance Rate map.
Applicant should also submit all applicable
information listed in section 151.21 of the Towns
Flood Damage Prevention Ordinance.
** P
lease note that an incomplete plan will result in a delay in the processing of the permit.**
APPLICANT AFFIDAVIT
I/We, the undersigned, do hereby make application and petition to the Planning Department of the Town
of Clayton to approve the subject Floodplain Development Permit. I hereby certify that all activities will be
carried out in compliance with the Unified Development Code and understand that violations will result in
a Code Enforcement action and fine. I further certify that I have full legal right to request such action
and that the statements or information made in any paper or plans submitted herewith are true and correct
to the best of my knowledge. I understand this application, related material and all attachments become
official records of the Planning Department of the Town of Clayton, North Carolina, and will not be returned.
Print Name Signature of Applicant Date
FOR OFFICE USE ONLY
PERMIT ACTION
PERMIT APPROVED: The information submitted for the proposed project was reviewed and is in
compliance with the approved floodplain management standards
PERMIT APPROVED WITH CONDITIONS: The information submitted for the proposed project
was reviewed. In order for the proposed project to be approved, certain restrictions or conditions must
be met. These restrictions or conditions are attached.
PERMIT DENIED: The proposed project does not meet approved floodplain management standards
(explanation on file)
VARIANCE GRANTED: A variance was granted from the base (1%) flood elevations established by
FEMA consistent with variance requirements of Title 44 of the Code of Federal Regulations part 60.6
(Variance action documentation is on file)
_______________
_________________________ _____________________________
Signature of community official Date
__________________________________________________
Print Name and Title of Community Official
September 2019
Page 3 of 3
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