SOW Att. 05 - KHC Cover Sheet 106 Review.pdf

Telephone:

Telephone: E-mail:

City/Township: County:

Latitude: Longitude:

Non-Construction Planning/RefinancingOther (describe):

KHC Preliminary Site Check #: OSA Preliminary Site Check #:

SECTION 5: IDENTIFICATION OF KNOWN HISTORIC PROPERTIES

SECTION 6: ATTACHMENTS - Attach all as applicable

Is there anything over 50 years of age in or visible from the project location? Yes No

E911 Street Address (or other description):

All documentation should be labeled with the project name or site address.

SECTION 4: PROJECT TYPE (please check all that apply)

Proposed Activity: Demolition Rehabilitation Structural Relocation Trails

Clear, current photographs of the project site and anything over 50 years of age in or visible from it.

Site map/plan indicating the exact location and boundaries of the project area.

Detailed description of the project (may include plans, scope of work, and other available information.)

Documentation of prior ground disturbance (e.g. maps, photographs, underground utility plans, etc.)

Any known information about the history/use of the property and local significance.

NOTE: Submit all information to Craig Potts, Executive Director/SHPO Via E-mail to:

khc.section106@ky.gov PAPER SUBMISSIONS WILL NOT BE ACCEPTED

If your project involves ground disturbance, has the site been previously disturbed?

Yes (describe in detail below) No

New Construction Land and/or Building Acquisition Sewer/Water Lines Roads/Bridges

Return Address:

SECTION 3: PROJECT LOCATION

SECTION 2: AGENCY INFORMATION

Funding/Permitting Agency:

KENTUCKY HERITAGE COUNCIL COVER SHEET

FOR SECTION 106 REVIEW AND COMPLIANCE

When federal (and some state) funds, permits or approvals are needed for a project, regulations such as 36 CFR Part 800 require these agencies or their delegates to consult with the Kentucky Heritage Council/State Historic Preservation Office regarding the project's potential effects on historic properties. To facilitate our review, please provide the following information and applicable attachments. Our office will generate a response within 30 days of receipt. Incomplete submissions may be returned for more information.

SECTION 1: APPLICANT INFORMATION

Project Sponsor or Applicant:

Contact Person (name & position):

Project Title:

Agency Contact Person (name & position):

KHC 106 Cover Sheet Version 4-18

E-mail:

We are no longer accepting paper documents for above or below ground review. Please submit all electronic documents for Section 106 Review to khc.section106@ky.gov. DO NOT SUBMIT ANY INITIAL SECTION 106 REVIEW MATERIALS TO AN INDEPENDENT REVIEWER. Failure to submit documents to the dedicated Section 106 email address will result in our staff not eceiving these documents for review.