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<br />, .. <br /> <br />.' <br /> <br />... <br /> <br />,~~~':RI~~~~~~~tt~~~~!~~I~.~~?~.j <br />, , ;. ,.",t8~RJ~1'~m':'~R~lli:I6,1.}:W:l@N""'""" ',' <br />l~'.<~ ;:'{.;', .~~ ;~';~,\,"~'i :'~ t lii \t:,:',~.: .. ;: ~',~ i);j;.::t: :':~:;:;i.~i :';..:;:,:r:: ,":~-,:},: t<?;. .,i "-'..;- :'~~:~:, <br /> <br /> <br />Submittal Date: <br />Owner's Name: Phone: <br />Mailing Address: Alt, Phone: <br /> Fax: <br />Project Address: <br />Legal Description: <br /> Acreage: <br />Contractor: <br />Address: <br />Street City State Zip <br />Describe Work: <br /> <br />*PLEASE 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 /> <br />**THIS AREA FOR CITY STAFF USE ONLY ** <br /> <br />o SKETCH REVIEWED <br />o SKETCH APPROVED <br />o PERMIT APPROVED <br /> <br />FLOOD ZONE: <br /> <br />BY I DATE: <br />BY I DATE: <br />BY I DATE: <br />BFE: <br /> <br />MAXIMUM NO. OF TRUCKLOADS: <br /> <br />SPECIAL CONDITIONS: <br /> <br />PERMIT NUMBER ISSUED: <br /> <br />DATE: <br /> <br />S:\CPShare\STANDARD FORMS\New Fill Dirt Permit Application.dwg <br /> <br />rev. date: 8/06/2002 rmo <br />