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<br />C. REVIEW FEE <br /> <br />Has the review fee for the appropriate request category been Induded? <br /> <br />181 Yes Fee amount: $.4..QQQ <br />o No, Attach Explanation <br /> <br /> <br />lions. <br /> <br />D. SIGNATURE <br /> <br />All documents submitted in support of this request are correct to the best of my knowledge. I understand that any false statement may be punishable <br />by fine or imprisonment under Title 18 of the United states Code, Section 1001. <br /> <br />Name: Gregory J. Koch <br /> <br />Company: Anderson ConsuJUng Engineers, Inc. <br /> <br />Mailing Addfess: <br /> <br />Daytime Telephone No_: <br />970-226-0120 <br /> <br />Fax No.: <br />970-226-0121 <br /> <br />772 Whalers Way, Suite 200 <br />Fort Collins, CO 80525 <br /> <br />Signature of Requester (required): <br /> <br /> <br />-Mail Address: gjkach@acewater.com <br /> <br />Date: <br /> <br />rz.. /, jo(, <br /> <br />As the community officialresponsibl or 0 ain management, I hereby acknowledge that we have received and reviewed this letter of Map <br />Revision (lOMR) 01' conditional LO R r uest. Based upon the community's review, we find the completed or proposed project meets or Is designed <br />to meet all of the community floodplain management requirements, including the requirement that no fill be placed in the regulatory fIoodway, and that <br />all necessary Federal, State, and local permits have been, or in the case of a conditlonallOMR, will be obtained. In addition, we have determined that <br />the land and any existing or proposed structures to be removed from the SFHA are or wlH be reasonably safe from flooding as defined in 44CFR <br />65.2(c), and that we have available upon request by FEMA, all analyses and documentation used to make this determination. <br /> <br />Community Official's Name and Title: Rex Bums, Floodplain Administrator <br /> <br />Telephone No.: <br />970-496-5721 <br /> <br />Community Name: Larimer County <br /> <br /> <br />Ignature (required): <br /> <br />Date: <br />J 01 v.lA IA lI"J q J .2 €)f;> 7 <br /> <br />CERTIFICATION BY REGISTERED PROFESSIONAL ENGINEERANDfOR LAND SURVEYOR <br /> <br />This certification is to be signed and sealed by a licensed land surveyor, registered professional engineer, or architect authorized by law to certify <br />elevation information. All documents submitted in support of this request are correct to the best of my knowledge. I understand that any false <br />statement may be punishable by fine or imprisonment under Title 18 of the United States Code, Section 1001. <br /> <br />Certifier's Name: Gregory J. Koch LIcense No.: 26367 <br /> <br />Expiration Date: <br />07/31/07 <br /> <br />Company Name: Anderson Consulting Engineers, Telephone No.: 970-226-0120 <br />Inc. <br /> <br />Fax No.: <br />970-226-0121 <br /> <br /> <br />Signature: <br /> <br />Date: <br /> <br />/2- / J /of.. <br /> <br />Required If ... <br /> <br />181 Riverine Hydrology and Hydraulics FOfm (Form 2) New or revised discharges or water,surface elevations <br /> <br />[8] Riverine Structures Form (Form 3) Channel is modified, addition/revision of bridge/culverts, <br />addlllon/revlsion of levee1floodwall, addition/revision of dam <br /> <br />o Coastal Analysis Form (Form 4) <br /> <br />o Coastal Structures Form (Form 5) <br /> <br />o Alluvial Fan Flooding Form (Form 6) <br /> <br />New or revised coastal elevations <br /> <br />Addition/revision of coastal structure <br /> <br />Seal (Optional) <br /> <br />Flood conlrol measures on alluvial fans <br /> <br />FEMA Form 81,89, SEP 02 <br /> <br />Overview & Concurrence Form <br /> <br />MT -2 Form 1 Page 2 of 2 <br />