Laserfiche WebLink
FILL DIRT/. PROPERTY ELEVATION�CHANGE <br />15 <br />PERrMITAPPLICATION` <br />Submittal Date: <br />Owner's Name: Phone: <br />Mailing Address: Alt. Phone: <br />Fax: <br />Project Address: <br />Legal Description: <br />Contractor: <br />Address: <br />Street <br />Describe Work: <br />Acreage: <br />city <br />State Zip <br />*PLEArSE,NOTE: -The Planning Department reserves the right to inspect ;the placement of soil <br />and recommend -changes as necessary to alleviate possible flooding of -neighboring properties. <br />**THIS AREA FOR CITY STAFF USE ONLY ** <br />❑ SKETCH REVIEWED BY / DATE: <br />❑ SKETCH APPROVED BY / DATE: <br />❑ PERMIT APPROVED BY / DATE: <br />FLOOD ZONE: BFE: <br />MAXIMUM NO. OF TRUCKLOADS: <br />SPECIAL CONDITIONS: <br />PERMIT NUMBER ISSUED: <br />c•\rt)n,,,mxC,rAA1n ADn PnOkAMM—o Fill Nrt Darmit Annliratinn.tiwv <br />DATE: <br />