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<br />'.INITIAL REVIEW FEE <br /> <br />!2(Ves 0 No <br /> <br />18. The minimum initial review Cee Cor Lhe appropriate requesL category has been included. <br /> <br />Initialfee amount: $ )It :7.00 <br /> <br />Check or money order only. Make check or money order payable t.o: National Flood Insurance Proaram. <br />paying by Visa or Mastercard please reCer to the credit card inCormation Conn which Collows this Corm. <br /> <br />or <br />19. This request is Cor a project that is Cor public benefit and is primarily intended Cor nood loss reduction to insurable <br />structures in identified nood hazard areas which were in existence prior to the commencement bC construction oC <br />the nood control project. 0 Ves 0 No <br /> <br />or <br />20. This request is to correct map errors, to include the effects oC natural changes within the areas of special nood <br />hazard, or solely to provide more detailed data.. 0 Ves 0 No <br /> <br />Note: 1 understand t,/)at. my.s.i~~~re indicates that all <br />inCormation submitted in support of this request is . <br />correct. <br /> <br />Note: SigDllture indicates that the community <br />understands, from the revision requester, the <br />impacts oCthe revision on nooding conditions <br />in the community. <br /> <br /> <br /> <br />/1(,~.l~'J ( 6rVTClI-) <br /> <br />Printed Nem. end Title of Revltion Request.r <br /> <br />W II { I A. ~ l=="("'(\l' t">1.~. \+-t'r <br />Printed Name and Title of CommunitY Offlci.1 <br /> <br />StCM Jje, <br /> <br />Jlvt.{}f' . 4rroC(t;,Ie. . L L c. <br />J <br />'. Com.pany Name <br /> <br />Te..lIuY'lito btn.ck J ?1.llokWo, <br />Community Name <br /> <br />72i-](// (Cf7o) <br /> <br />Telephone No. <br /> <br />S/!lltt <br /> <br />. Dati <br /> <br />S/;-7 /qt <br /> <br />I 6ate <br /> <br />Does this request impact any other communities? 0 Ves ~ No <br /> <br />if yes, attach lettars from all affected jurisdictions acknowledging revision request and approving changes t.o noodway, <br />if' applicable. <br /> <br />Note: Although a photogr@ph ofphy~ical changes is not required, it may be helpful for FEMA's review. <br /> <br />llevlsion lie_dO. and c-munity Officiel Fewm <br /> <br />MT.2 Fonn I <br /> <br />'...8of8 <br /> <br />