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GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF PERMITS STX DISTRICT TEL: (340) 773-1082 STT/STJ DISTRICT TEL: (340) 774-3320 APPLICATION for FLOOD HAZARD PERMIT ___________________________ ___________________________ FZP NO RECEIPT NO. ___________________________ ___________________________ QUARTER DATE Property Owner/Applicant __________________________________________ ________________ _______________________________________ (First Name) (M.I.) (Last Name) Address: __________________________________________________________________________________________ City:______________________________ Island:________________________ USVI Zip Code:____________________ Telephone (Cell) ___________________ (Home) _______________________ (Work) __________________________ Engineer, Architect, Land Surveyor (If Applicable) __________________________________________ _________________ ______________________________________ (First Name) (M.I.) (Last Name) Street Address: _____________________________________________________________________________________ Mailing Address: ___________________________________________________________________________________ Telephone (Cell): ______________________ (Home): ______________________ (Work) ________________________ Seal and Signature of Licensed USVI Engineer, Architect, or Land Surveyor. PROJECT INFORMATION Site Location (Address, Property Description, or Lot Number) **Attach Flood Map (FIRM) and show property location. __________________________________________________________________________________________________ __________________________________________________________________________________________________ SIGN PROPOSED DEVELOPMENT ☐ New Construction ☐ Residential ☐ Non-Residential ☐ Improvement of Existing Structure Value of Existing Structure ________________________ Value of Proposed Improvement _______________________ ☐ Manufactured Home Within existing manufactured home park or subdivision ____________________________________________________ Outside existing manufactured home park or subdivision ____________________________________________________ Fill (amount and type) _______________________________________________________________________________ Alteration of Water Course (Describe and attach sheet) FLOOD HAZARD ZONE Please Check (ONE) ☐ A ☐ AO ☐ AH ☐ A1-30 ☐ AE ☐ V ☐ V1-30 ☐ VE Flood Source (Name of Waterway, etc.) _________________________________________________________________ Floodway? Please Check (ONE) ☐ YES ☐ NO (If yes, Step-Backwater Analysis Required) Base Flood Elevation ________________________________________________________________________________ FEMA Map Panel Number __________________________________ Map Date _________________________________ Certificate of Elevation File Date _______________________________________________________________________ DEPARTMENTAL USE ONLY ☐ Approved ☐ Disapproved Comments: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Signature: ___________________________________________ Date: ________________________________________ CERTIFICATE OF COMPLIANCE FOR FLOODPLAIN DEVELOPMENT (Applicant must fill in all pertinent information in Section A including sections numbers 1 and/or 2.) SECTION A Premises Location: __________________________________________________________________________ Permit No.: ____________________________________ Variance No._________________________________ Project Type: ___________________________________ Date: _____________________________________ 1. I certify that I have completed the above project in accordance with the Community’s floodplain management regulations and have met all the requirements which were conditions of my permit. I now request the completion of this Certificate of Compliance by the program administrator. Date: ______________________________ ______________________________________________________ Signature 2. I certify that I have completed the above project in accordance with conditions of variance number ____, dated ________________, to the Community’s floodplain management regulations, and have met all requirements which were a condition of the variance. I now request the completion of this Certificate of Compliance by the program administrator. Date: ______________________________ ______________________________________________________ Signature DEPARTMENTAL USE ONLY SECTION B (Local Administrator will complete, file, and return a copy to the applicant.) Floor Slab Elevation Date: _______________________ Inspected By: _________________________________ Inspector’s Signature This certifies that the above-described floodplain development complies with the requirements of Flood Damage Prevention Local Law Number _______ or has a duly granted variance. Signed: ________________________________________ Date: ______________________________________ Please (LIST) Supporting Certifications: Floodproofing, elevation, hydraulic analysis, etc. ________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________