Flood Plain Development Permit Application
Building Department, 517 8th Ave E, Williston ND 58801 Phone: (701) 577-8115 Fax: (701) 577-2081
PERMIT APPLICATION
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Date: _____________
Applicant _________________________________ Daytime Phone ___________________________
Address __________________________________
Project No. __________________________________
PCN: ___________________________________
Legal_____________________________________________________________________________
Brief Project Description: _____________________________________________________________
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Contractor: ________________________________________________________________________
Daytime Phone: ____________________________________________________________________
Address: __________________________________________________________________________
Estimated Cost of Project: ______________________________________
FLOOD PLAIN DETERMINATION:
(Complete the appropriate information)
Project is located
100 year floodplain? (Flood Fringe):
Regulatory Floodway:
Map Information:
FIRM Panel:
FIRM Date:
FIRM Zone:
BFE at Site:
Development will be elevated to:
- Yes - No
- Yes
 - No
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DEVELOPMENT ACTIVITIES: (check all that apply and explain the activity)
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Fill placement
(fill brought in from outside the floodplain)
Excavation
(where subgrade fill is removed from the floodplain)
Landscaping
(cut and fill, fill borrow and placement)
Construction or maintenance of a dike/levee/floodwall
Removal of fill, embankment, or dikes
Watercourse alterations (river, stream, lake – channel modifications, rip-rap)
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Road, street or bridge construction (new, repair or replacement, realignment)
Drainage improvements (including culvert work)
Mining (removal of gravel, rock, fill or other natural materials)
Installation of utilities (water, sewer, pipeline, gas, electric, communications)
Well drilling (water, oil, natural gas, etc.)
Subdivision (new or expansion)
Other (temporary features, please specify and describe)
Explanation of Activities:
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ADDITIONAL INFORMATION NEEDED
Agency
Type of Approval
Date Submitted
Date Received
OTHER NOTIFICATION OR PERMITS NECESSARY?
U.S. Army Corps of Engineers – ____________________________________________________
County Water Resource District – ___________________________________________________
Neighboring political entities – _____________________________________________________
ELEVATION INFORMATION:
Attach information about the completed project elevations with registered professional engineer or
registered land surveyor certifications if required for National Flood Insurance recordkeeping. –
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ACTION/APPROVAL:
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PERMIT APPLICATION IS:
APPROVED
DENIED
Conditions: ________________________________________________________________________
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Signature of Floodplain Administrator: __________________________________________________
Date: ________________________________________
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