Plainfield Township

1 Floodplain Permit Application Permit # _____ Site/Contact Information Site Address: _____ Primary Contact Person (check one) Property Owner Name Address Phone Email Applicant Name Address Phone Email Contractor Name PA Contractor s # Address Phone Email Project Type New Construction Addition Renovation/Alteration Driveway Covered/Enclosed Porch Flood Damage Repair Pool/Hot Tub Mechanical/Electrical/Plumbing Other:_____ Deck/Patio Detached Garage/Shed/Pole Barn Total Cost of Improvements: $_____ Flood damage related costs (if applicable): $_____ Market Value of Property (if property suffered flood damage, use pre-damage market value) $_____ Brief Description of Project: _____ _____ Check each box below indicating that all of the following will be submitted with this application: Two (2) copies of site plan with floodplain location shown Two (2) complete sets of construction drawings Print Name of Applicant: _____ Signature of Applicant: _____ Date: - _____ Print Name of Owner: _____ Signature of Owner: _____Date:_____ Page 1 of 2 Please complete page 2 By signing this form, the owner also gives Plainfield Township officials permission to access the property for all necessary Township6292 Sullivan TrailNazareth, PA 18064 Phone: (610) 759-6944 Fax: (610) 759-1999 Website: Is any part of this property located within a Special Flood Hazard Yes No If so, which zone(s)?

2 _____ Is any part of the principal structure on this property located within a Special Flood Hazard Yes No If so, which zone(s)?_____ Are there any existing bodies of water (ponds) or water courses (creeks, streams, rivers, or water channels) located on this property? Yes No If so, please If you answered yes to any of the questions above, please complete the following: Check other necessary government permits required by the state and/or federal laws. NPDES Permit (over 1 acre of earth disturbance) Act 537 Sewage Facilities Planning Dam Safety and /or stream encroachment Wetlands encroachment Other _____ Have those permits been obtained? Yes No If so, please provide copies. Do you possess an elevation certificate? Yes No If so, please provide a copy. Will any chemicals/fossil fuels be stored on the property? Yes No If so, list type and amount.

3 _____ Will the proposed construction or development require the use of fill? Yes No Is this property located in a historic district or on a national historical registry? Yes No Has this property obtained a variance from any provision of the Yes No Page 2 of 2 If construction of development is proposed within any Identified Floodplain Area, please provide statements orplans that address compliance with all relevant provisions of the Plainfield Township zoning ordinance FloodHazard Overlay District Regulations (Section 507, as amended).Area?Area? Plainfield Township Floodplain ordinance ?Northampton County Conservation District Erosion and Sedimentation Pollution Control Plan ReviewPlainfield Township Stormwater Management Ordinanc