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<br /> DEPARTMENT OF HOMELAND SECURITY-FEDERAL.EMERGENCY MANAGE Nit Nt Mir NCy vt>Ae.arm. Iaaalools
<br /> COMMUNITY ACKNOWLEDGMENT FORM I repnerr.bvt_Y r iota fl•
<br /> PAPERWORK BURDEN DISCLOSURE NOTICE
<br /> nuhh,rnp,sting burden for this,Iata t tiiktrtion is estimated to average 1.re hours per response. the Gulden estimete includes the time tot;eviewmg insuutrium,
<br /> seen-tuna,akfing data sources,gathering and maintaining the needed data,and completing end submitting the farm, this toilectl n is requtted to obtain or raise"
<br /> benefits. you are not requited to respond to this collection of Information unless a valid DMB control number it displayed on this form fiend etunnterds regtrdtnit
<br /> the acruraty of the border estimate and any suggestions for reducing this burden to;informetlen Cnika•tions Management,tiepartment of Homeland set Indy, It
<br /> Federal I. MO Management Agency, O South Ileti Street,Arlington,VA 1059111-MOS,Paperwork'Urdu(lion Project(l660 0015) Wit t ct not send your I
<br /> completed term to this address.
<br /> This form must be completed lot requests involving the existing or proposed placement of fill(co mplte Section A)OR to prUvide atknowiedyjtierd of tIes request i•-
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<br /> remove a property from the Sri IA which was prcvi„u-,iy lur aied within the regulatory floodway(complete Section II) Q
<br /> '.- This form must be completed and signed by the official responsible lot Iloo dplein management in the cormnunity. The silt digit Nile community number and the
<br /> subject property address must appear in the spaces provided below, Incomplete submissions will result In processing delays.Please refer to the Mt 1 uwiructt,;... 4
<br /> additional information about this torn
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<br /> . .,•a .. :;,r .-•mmunity Number: Property Name or Address: tar Gt 10 3 m 1 i fU.W..AL_A 06
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<br /> 1 A, REQUESTS INVOLVING THE PLACEMENT OF FM
<br /> As the community official responsible for floodplain management,I hereby acknowledge that we have received and reviewed this Letter of Map
<br /> Revision Based on Fill(LOMR-F)or Conditional LOMR-F request. Based upon the community's review,we find the completed or proposed project -1 r
<br /> l—t' meets or is designed to meet all of the community foodplain management requirements,Including the requirement that no fill be placed in the
<br /> regulatory floodway,and that all necessary Federal,State,and local permits have been,or in the case of a Conditional I OMR F,will be obtained
<br /> For Conditional LOMR-F requests,the applicant has or will document Endangered Species Act(ESA)compliance to FFMA prior to issuance of the
<br /> Conditional LOMR-F determination.For LOMR-F requests,I acknowledge that compliance with Sections 9 and 10 of the ESA has been achieved
<br /> independently of FEMA's process.Section 9 of the ESA prohibits anyone from"taking"or harming an endangered species. If an action might harm ,
<br /> an endangered species,a permit is required from U.S.Fish and Wildlife Service or National Marine Fisheries Service under Section 10 o1 the ESA
<br /> For actions authorized,funded,or being carried out by Federal or State agencies,documentation from the agency showing its compliance with
<br /> Section 7(a)(2)of the ESA will be submitted.In addition,we have determined that the land and any existing or proposed structures to be removed
<br /> from the SFHA are or will be reasonably safe from flooding as defined in 44CFR 65 2(c),and that we have available upon request by OHS FEMA,aii
<br /> analyses and documentation used to make this determination, For LOMR-F requests,we understand that this request is being forwarded to OHS
<br /> FEMA for a possible map revision
<br /> Community Comments: t
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<br /> Community Official's Name and Title (Please Print or Type rr Telephone No
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<br /> Community Name: Co nity fficial's ature: (required) Date
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<br /> B. PROPERTY LOCATED WITHIN THE REGULATORY FLOODWAY
<br /> As the community official responsible for floodplain management,I hereby acknowledge that we have received and reviewed this request for o
<br /> LOMA. We understand that this request is being forwarded to DHS-FEMA to determine if this property has been inadvertently included in the
<br /> regulatory floodway. We acknowledge that no fill on this property has been or will be placed within the designated regulatory floodway We find
<br /> that the completed or proposed project meets or is designed to meet all of the community floodplain management requirements
<br /> Community Comments:
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<br /> Community Official's Name and Title: (Please Print or Type) Telephone No.:
<br /> Community Name: 1 Community Official's Signature(required): Date:
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<br /> DHS-FEMA Form 086-0-26B,FEB 11 Community Acknowledgment Form MT-1 Form 3 Page 1 of 1
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