Flood History Record

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THIS IS TO BE COMPLETED BY THE REPRESENTATIVE SEEKING A FLOOD DEBASEMENT.  EACH PARCEL NUMBER REQUIRES A NEW FORM.  YOU MUST ALSO ATTACH A FLOOD CHART AND AN AERIAL MAP, WHICH ARE AVAILABLE AT THE CCAO OFFICE.   
   

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FLOOD HISTORY RECORD


______-____-______-______-______-__________-___________.___________          ______________________________     
Parcel Number                                                                                                Date

_______________________________________________________   _____________________________________________
Name                                                                                          Address

(_____)_______-___________    ___________________________________________  _______________________________
Phone                                    Email Address                                                       Signature

Past   10 Years

20

20

20

20

20

20

20

20

20

20

 

Did   cropland flood? yes/no

 

 

 

 

 

 

 

 

 

 

 

Source   of flooding?

 

 

 

 

 

 

 

 

 

 

 

Months   flooding occurred?

 

 

 

 

 

 

 

 

 

 

 

Type of crop   planted

 

 

 

 

 

 

 

 

 

 

 

Number of acres   planted

 

 

 

 

 

 

 

 

 

 

 

% of crop loss

 

 

 

 

 

 

 

 

 

 

 

Comments:_____________________________________________________________________________________________

 ________________________________________________________________________________________________________

 ________________________________________________________________________________________________________

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