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<br />" F'~OJECT APPHOVAL INfORMAT'~N <br /> <br />GJl)-3 <br /> <br />ilf'lm 1, <br />Does this assistance request require' stale, local, <br />regional, or other priority rating? <br /> <br />iJ Yes ''Q) No <br /> <br />Name of Governing Body <br />Priority Rating <br /> <br />HRlm 2. <br />Does this assistance request require slate, or local <br />advisory, educational, or health clearance? <br /> <br />!31 Yes 0 No <br /> <br />Name of Agency or Soard <br />(Attach Documentation) <br /> <br />H~m 3.. <br />Does this assistance req)Jest require T?ACS review? (A!lach Comments) <br /> <br />~ Yes 0 No <br /> <br />',~ - I <br />,,'-;.<1 .., <br /> <br />.....'....6S ~.,S ...ce:c:."'-,,,,,- r6.....,-c::t "'-~l,:r::l c:::.....p 1....,......1 <br />.....0./ ,I' c:..;;-.;>._IC.lo,....:;:: ,~..n:._. ,~"",""'J._ _1C.1_, ......"':::.,. <br />:=;.icnall or c.:h;r p!E:ming ap~ro\'2.!? <br /> <br />;] Yes <br /> <br />U" No <br /> <br />,.=...... l; <br />, ~J' <br /> <br />is the proposed project cover6o by an apP;O,,":3-d <br />comprehensi','e plan? <br /> <br />31 Yes <br /> <br />o No <br /> <br />:t.::m6. <br />\'."111 the assistance request&d serve a fede;a1 <br />installation? <br /> <br />~ Yes <br /> <br />o No <br /> <br />Item 7 <br />\'1"111 the .assis tan ce" required be on federal land or <br />installation? <br /> <br />o Yes <br /> <br />[j No <br /> <br />I~:! R <br />\'lr:1I the assistance req:Jested have an impact or <br />effect on the environment? <br /> <br />o Yes <br /> <br />U No <br /> <br />!~?rn 9. <br />Will the assistance rsquested cause the displace. <br />ment of individuals, families, businesses or farms? <br /> <br />!.J Yes <br /> <br />uL No <br /> <br />lj:.m -10 <br /> <br />Na..7lIE c~ .t..pproviiiQ .L.g-enc)' <br />~= <br /> <br />Check One: U <br />o <br />o <br />Location 01 Plan <br /> <br />S:a!e <br />local <br />;:;59;ona1 <br /> <br />Name of Federallnstalla~on <br />Federal PopJlaiion Oenefiting irom Project <br /> <br />". <br /> <br />Name of Federallnstallalion <br />location of F ede;a1 Land <br />Percen! of P,ojee! <br /> <br />See instrUctions for additional information ic :,e <br />provide.d. <br /> <br />Number of: <br /> <br />Individua!s <br />~EmHies <br />Businesses <br /> <br />r2..rms <br /> <br />:5 there other related assistance 0'1 this project <br />previous, pending, or anticipcted? <br /> <br />J! Yes 0 No <br /> <br />See instructions for additior.el inlormetion to be <br />provided. <br /> <br />",1'''1 " <br />is the project in a Oes.gnated flood haz<.rd area? <br /> <br />!.J Yas 31 No <br /> <br />See i:istructicns 10; a::i::ii:ic:-,al inior7nctionlo De <br />provide.d. <br />