8630 Supp 7 - THC Request for SHPOREQUEST FOR SHPO CONSULTATION:
Section 106 of the National Historic Preservation Act and/or the Antiquities Code of Texas
This is a new submission.
This is additional information relating to THC tracking number(s):
Project Information
PROJECT NAME
PROJECT ADDRESS PROJECT CITY PROJECT ZIP CODE(S)
PROJECT COUNTY OR COUNTIES
PROJECT TYPE (Check all that apply)
Road/Highway Construction or Improvement
Site Excavation
Utilities and Infrastructure
New Construction
Repair, Rehabilitation, or Renovation of Structure(s)
Addition to Existing Structure(s)
Demolition or Relocation of Existing Structure(s)
None of these
BRIEF PROJECT DESCRIPTION: Please explain the project in one or two sentences. More details should be included as an attachment to this form.
Project Contact Information
PROJECT CONTACT NAME TITLE ORGANIZATION
ADDRESS CITY STATE ZIP CODE
PHONE EMAIL
Federal Involvement (Section 106 of the National Historic Preservation Act)
Does this project involve approval, funding, permit, or license from a federal agency?
Yes (Please complete this section)No (Skip to next section)
FEDERAL AGENCY FEDERAL PROGRAM, FUNDING, OR PERMIT TYPE
CONTACT PERSON PHONE
ADDRESS EMAIL
State Involvement (Antiquities Code of Texas)
Does this project occur on land or property owned by the State of Texas or a political subdivision of the state?
Yes (Please complete this section)No (Skip to next section)
CURRENT OR FUTURE OWNER OF THE PUBLIC LAND
CONTACT PERSON PHONE
ADDRESS EMAIL
Please see instructions for completing this form and additional information on Section 106 and Antiquities Code
consultation on the Texas Historical Commission website at http://www.thc.state.tx.us/crm/crmsend.shtml.
VER 0811
Identification of Historic Properties: Archeology
Does this project involve ground-disturbing activity?
Yes (Please complete this section)No (Skip to next section)
Describe the nature of the ground-disturbing activity, including but not limited to depth, width, and length.
Describe the previous and current land use, conditions, and disturbances.
Identification of Historic Properties: Structures
Does the project area or area of potential effects include buildings, structures, or designed landscape
features (such as parks or cemeteries) that are 45 years of age or older?
Yes (Please complete this section)No (Skip to next section)
Is the project area or area of potential effects within or adjacent to a property or district that is listed in or
eligible for listing in the National Register of Historic Places?
Yes, name of property or district:No Unknown
In the space below or as an attachment, describe each building, structure, or landscape feature within the
project area or area of potential effect that is 45 years of age or older.
ADDRESS DATE OF CONSTRUCTION SOURCE FOR CONSTRUCTION DATE
ADDRESS DATE OF CONSTRUCTION SOURCE FOR CONSTRUCTION DATE
ADDRESS DATE OF CONSTRUCTION SOURCE FOR CONSTRUCTION DATE
Attachments
Please see detailed instructions regarding attachments.
Include the following with each submission:
Project Work Description
Maps
Identification of Historic Properties
Photographs
For Section 106 reviews only, also include:
Consulting Parties/Public Notification
Area of Potential Effects
Determination of Eligibility
Determination of Effect
For SHPO Use Only
Submit completed form and attachments to the
address below. Faxes and email are not acceptable.
Mark Wolfe
State Historic Preservation Officer
Texas Historical Commission
P.O. Box 12276, Austin, TX 78711-2276 (mail service)
108 W. 16th Street, Austin, TX 78701 (courier service)
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REQUEST FOR SHPO CONSULTATION -- PROJECT NAME: