Breathitt County
Local Floodplain Permit Application

Please fill out this form entirely and submit by using the ‘Submit’ button below.

Name

First Name

Last Name

Phone

Project Location

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you obtained a permit from the Kentucky Division of Water?

Yes

Will any stream or wetlands be impacted?

Yes

Comments or Explanations

Name of person completing application

Today's Date

YYYY