<p> OWENSBORO METROPOLITAN Floodplain Construction PLANNING COMMISSION Permit Application 07/02 305FCA</p><p>Complete this permit application form ONLY for proposed Day Telephone construction in a regulatory floodplain of bridges, culverts, walls, and other structures that are not roofed buildings. Otherwise, see Dates of proposed construction activity OMPC Form 301 for proposed construction of roofed buildings Estimated BEGIN Date and OMPC Form 305A for proposed excavation, cut or fill activity. Reference: Zoning Ordinance, Sections 18-2, 18-3(c), 18-4. Estimated END Date KRS Chapter 151 requires approval from the Kentucky Division of Description of structure(s) and activity Water prior to any activity in or along a stream that could in any way obstruct flood flows. __ PENDING STREAM CONSTRUCTION PERMIT from Date Submitted Kentucky Division of Water Location of proposed activity __ APPROVED STREAM CONSTRUCTION PERMIT ATTACHED including application documents submitted to state. Give street address or other directions, stream name and mile, latitude, longitude, etc., as best describes location of __ STRUCTURE(S) depicted on OMPC-approved development construction activity. plan, subdivision plat, or public facility review.</p><p>__ NO STREAM CONSTRUCTION PERMIT REQUIRED: In this case, give specifications, type, and purpose of the proposed structure(s). Use attachment, if necessary.</p><p>DESCRIBE STRUCTURE(S) and accessory cut or fill Type of proposed construction activity activity: __ Bridge __ Culvert __ Other, specify below:</p><p>______Will project affect a regulatory floodway? __ No __ Yes </p><p>Landowner List of attachments Name, Address __ APPROVED STREAM CONSTRUCTION PERMIT ATTACHED including documents submitted to state.</p><p>__ PROFESSIONAL ENGINEER CERTIFICATIONS regarding effects on regulatory floodways (if applicable).</p><p>Day Telephone __ OTHER: List plans, profiles, maps, data, etc. submitted to document the proposed activity described above. Applicant, if other than landowner Name, Address</p><p>Signature of Landowner and Applicant Day Telephone We hereby request approval to construct a structure or structures within a regulatory floodplain as described hereon and by the Engineer, if applicable attached documents. To the best of our knowledge, all Name information provided is true and correct.</p><p>______Landowner's Signature Date P. E. Number Day Telephone ______Contractor, if applicable Applicant's Signature Date Name FOR OFFICIAL USE ONLY</p><p>270-687-8650 PLANNING • Zoning • Subdivision • Addresses • Street Access Points FAX 270-687-8664 270-687-8665 BUILDING & ELECTRICAL • Plan Review • Permits • Inspections Serving Owensboro, Whitesville, and Daviess County, Kentucky – www.iompc.org Excavation, Cut or Fill OMPC Permit Application 09/01 305A 2/2</p><p>______City/County Engineer’s Signature Date</p>