HomeMy WebLinkAboutGore Creek Signed Copy.pdf MUST BE SUBMITTED AND APPROVED PRIOR TO RELEASE OF PUBLIC WAY OR BUILDING PERMIT
APPLICATION FOR
FLOODPLAIN USE PERMIT
PRJ#: Town of Vail
FLIM; Public Works Dept
Parcel 1309 Elkhorn Dr
Bldg Permit#: B - _ Vail.CO 81657
WARNING: Inclusion of false information in this permit application establishes an automatic denial fora Floodplain Use
Permit and forfeiture ofapplication fees. By signing this permit,the applicant declares heshe has read all contents of this
document and Title 12-21 of the Town of Vail Code.Application Fee:$300.00
Applicant Name: i 4.1,/t i Op- V4 t+- Phone: 9 7 0 390- 3 Z
City/State/
Applicant Address: 15 ... - 2-0 Zip: _ VAii 1 b$ 7
Contractor Name/ Applicant
License Number: Email: cab ai'r f e.ts2 it ;
Contact
Contact Name: 0 f _._ Phone: 7 O 39 Q3 ze(�
FEMA Floodplain Panel Number: FEMA Profile Sheet Number: _
(http://msc.fema.gov FEMA Adopted Floodplain December 4th,2007)
Floodplain Use Location(Address or Lot&Block): V,+}I L Lt 05-4 "pc; Pr r_{NG I /kZ-rcq—
Floodplain Use Description(Purpose): A+-, t.- Sri 0t t_+ z#t-7.10
Requestedf
Dates of Use: 4 21 / to 4?III Z_I 18
Minimum Required Submittals(Additional submittals may be required on a case by case basis):
❑ Site plan at an engineering scale showing the location,dimensions,and elevations of the proposed
landscape/grade alterations, existing and proposed structures, relevant landscape/topographic
features, and the location of the foregoing in relation to the one hundred year floodplain.The
floodplain line shall be provided on a plan certified by a licensed professional engineer or land
surveyor. Survey datum shall match FEMA map Datum.
❑ Detailed topographic cross-sections provided by a licensed professional surveyor of the area
proposed to be altered,showing existing and proposed conditions.
❑ Description of the extent to which any floodplain will be altered including;why,when, how, and
when it will be replaced back to Its original configuration, and addressingleach relevant criteria in
Subsection 12-21-11 E-3.
❑ Copy of all other necessary approved permits(i.e.ACOE permit, Dewatering permit, DOW permit,
CDHPE permit,etc...)
❑ If required by the Floodplain Administrator, an engineered floodplain analysis of the impacts to the
floodplain prepared by a qualified licensed professional engineer.
❑ Submitted application for a conditional FIRM and floodway revision through FEMA, if applicable.
Applicant must contact Public Works Department at 479-2198 24 hours prior to commencing of work.
Failure to notify the Town will result in forfeiture of bond money.
012-EG a, .73 4-.242./ / 3/is
Print Applicant Name ,pt ant Signature Dale
OFFICE USE ONLY
0 Approved 0 Denied
Review By Date Comments
F:1Pw\Enginccring\Floodplains\Floodplain Pcrmits\Floodplain Use PermitsWldP1nUsePermit Application.doc