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U.S. DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.7660-0015 PROPERTY INFORMATION FORM EapiresDecember37'Zolo PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this form is estimated to average 1.63 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data, and completing, reviewing,and submitting the form. You are not required 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 the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, U.S. Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW,Washington DC 20472, Papervvork Reduction Project(1660-0015). Submission of the �orm is required to obtain or retain benefits under the Nationai Flood Insurance Program. Piease do not send your compieted survey to the above address. This form may be compieted by the property owner, property owne�'s agent, licensed land surveyor, or registered professional engineer to support a request for a Letter of Map Amendment(LOMA), Conditional Letter of Map Amendment(CLOMA), Letter of Map Revision Based on Fill(LOMR-F), or Conditional Letter of Map Revision Based on Fill(CLOMR-F)for existing or proposed,singie or multiple lots/structures. In order to process your request, ail information on this form must be compieted in its entirety. Incomplete submissions may result in processing delays. Please check the item below that describes your request: LOMA A letter from DHS-FEMA stating that an existing structure or parcel of land that has not been elevated b fill(natural rade wou(d not be inundated b the base flood. ❑ CLOMA A letter from DHS-FEMA stating that a proposed structure that is not to be elevated by fill (natural grade)would not be inundated by the base flood if buiit as proposed. ❑ LOMR-F A letter from DHS-FEMA stating that an existing structure or parcel of land that has been elevated by fill would not be inundated by the base flood. ❑ A letter from DHS-FEMA stating that a parcel of land or proposed structure that will be elevated by CLOMR-F fill would not be inundated by the base flood if fill is placed on the parcel as proposed or the structure is built as proposed. Fill is defined as material from any source(including the subject property)ptaced that raises the ground to or above the Base Flood Elevation (BFE). The common construction practice of removing unsuitable existing material(topsoil)and backfilling with select structural material is not considered the placement of fill if the practice does not alter the existing(natural grade)elevation,which is at or above the BFE. Fill that is placed before the date of the first National Flood Insurence Program(NFIP)map showing the area in a Special Flood Hazard Area(SFHA)is considered natural grade. Has fill been placed on your property to raise �.�( ground that was previously below the BFE? ❑ Yes W No If yes,when was fill placed? / I— month/year Will fill be placed on your property to raise ground that is below the BFE? ❑ Yes� No If yes,when will fill be placed? / month/year 1. Street Address of the Property(if request is for multiple structures,please attach additional sheet): Sl�e ►�� lt�►n.c� �l� 2. Le al descri tion of Pro e ��b�C�; '�/ � `S��G' g p p rty(Lot,Block,Subdivision)(complete description as it appears in the Deed is not necessary): K��h e 1� S�,�i ��v�� -t� �a- � �� -a� 3. Are you requesting that the SFHA designation be removed from(check one): � the entire legally recorded property? a portion of land within the bounds of the property?(A certified metes and bounds description and map of the area to be removed, cert�ed by a licensed land surveyor or registered professional engineer, are required. For the preferred format of inetes and bounds descriptions,please refer to the MT-1 Form 1 Instructions.) ❑ structures on the property? What are the dates of construction? 4. Is this request for a(check one): � single structure � single lot ❑ multiple structures(How many structures are involved in your request?List the number. ) ❑ muftiple lots(How many lots are involved in your request?List the number. ) DHS-FEMA Form 81-87,DEC 07 Property Information Form MT-1 Form 1 Page 1 of 2