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U.S. DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY D.M.B.NO.1660-DOIS <br /> COMMUNITY ACKNOWLEDGMENT FORM ExpiresDecember3l,zo�o <br /> PAPERWORK BURDEN DISCLOSURE NOTICE <br /> Public reporting burden for this form is estimated to average 1.38 hours per response. The burden estimate includes the time for reviewing instructions, <br /> searching existing data sources,gathering and maintaining the needed data,and completing, reviewing, and submitting the form. You are not required <br /> to respond to this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding <br /> the accuracy of the burden estimate and any suggestions for reducing this burden to: InfoRnation Coilections Management, U.S. Department of <br /> Homeland Security Federal Emergency Managemsnt Agency, 500 C Street, SW,Washington DC 2Q472, Paperwork Reduction Project(1660-0015). <br /> Submission of the form is required to obtain or retain benefits under the National Fiood Insurance Program. Ptease do not send your completed <br /> survey to the above address. <br /> This form must be completed for requests involving the existing or proposed placement of fill (complete Section A) OR to provide acknowledgment of <br /> this request to remove a property from the SFHA which was previousiy located within the regulatory floodway(complete Section B). <br /> This form must be completed and signed by the official responsible for floodplain management in the community. The six digit NFIP community <br /> number and the subject property address must appear in the spaces provided below. Incomplete submissions may result in processing delays. <br /> Community Number. Property Name orAddress: <br /> ��7 �`7�j ��D� �t� � 5��►'l � <br /> A. REQUESTS INVOLVING THE PLACEMENT OF FILL <br /> As the community officiai responsible for floodplain management,I hereby acknowledge that we have received and reviewed this Letter of Map Revision <br /> Based on Fill(LOMR-F)or Conditional LOMR-F request. Based upon the community's review,we find the completed or proposed project meets or is <br /> designed to meet ai!of the community floodplain management requirements, including the requirement that no fill be placed in the regulatory floodway, <br /> and that ali necessary Federai,State,and local permits have been,or in the case of a Conditional LOMR-F,will be obtained. In addition,we have <br /> determined that the land and any existing or proposed structures to be removed from the SFHA are or will be reasonably safe from flooding as defined in <br /> 44CFR 65.2{c),and that we have available upon request by DHS-FEMA,all analyses and documentation used to make this determination. For LOMR-F <br /> requests,we understand that this request is being forwarded to DHS-FEMA for a possible map revision. For LOMR-F or Conditional LOMR-F requests <br /> that have the potential to impact an endangered species,documentation will be submitted to show that we have complied with Sections 9 and 10 of the <br /> Endangered Species Act(ESA). Section 9 of the ESA prohibds anyone from`taking"or harming an endangered species. If an action might harm an <br /> endangered species,a permit is required from U.S.Fish and Wildlife Service or National Marine Fisheries Service under Section 10 of the ESA. For <br /> actions authorized,funded,or being carried out by Federal or State agencies,documentation from the agency showing its compliance with Section <br /> 7(a)(2)of the ESA will be submitted. <br /> Community Comments: <br /> Community Official's Name and Title_ (P/ease Print or Type) Telephone No.: <br /> Community Name: Community Official's Signature: (required) Date: <br /> B. PROPERTY LOCATED WITHlN THE REGULATORY FLOODWAY <br /> As the community official responsible for floodplain management, I hereby acknow(edge that we have received and reviewed this <br /> request for a LOMA_ We understand that this request is being forwarded to DHS-FEMA to determine if this property has been <br /> inadvertently incfuded in the regulatory floodway. We acknowledge that no fill on this property has been or will be placed within the <br /> designated regulatory floodway. We find that the completed or proposed project meets or is designed to meet all of the community <br /> floodplain management requirements. <br /> Community Comments: <br /> r",`t C>'.��'c:. i� 1 CaC'<��c'CI Civ�t r���w�� h�c:�In ���c��v��,r <br /> Community Official's Name and Title: (Please Print or Type) Telephone No.: <br /> �U� � ivv`i�12 �/ � �t� r��l��pV���/ I`a�' -7�(C� - i��� <br /> Community Name: CommuenitqOfficiafs SigyPature(required): Date: <br /> ��� o� � i vU�c� 1�,.� �.;� ,._ �, ,z jL���c:�t <br /> DHS-FEMA Form 81-876,DEC 07 Community Acknowledgment Form Page 1 of 1 <br />