MONTGOMERY COUNTY DEVELOPMENT PERMIT APPLICATION - Non-Structure Permit #: Application Date: ‘Commissioner Precinct: Applicant's Name: Mailing Address: Permit Fee: __$200.00 F.LR.M, Panel # HM# Phone #: City: Owner's Name: Mailing Address: State: Zip: Phone # City: Property Description: State Zip: Survey Name: 1) AbstractNo.: 1) 2) 2 3) 3) Defined Location: Development is Residential ‘Commerical Square Footage / Area of Development (Commercial atach Guidlines for Commercial Permit In Montgomery County) Is Property in Floodplain? Is Property in Floodway? Yes No Watershed: 1) 2 Development Type: Channel Fill Impervious Cover Bulkhead Retaining Wall Grading Purpose: Eefects: NOTICE * Any person securing a permit does so on the representation to Commissioner's Court that he/she will comply with all requirements and ‘county regulations, and obtain all necessary permits required for this property. ‘Applicant Signature Date