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FOR OFFICE USE ONLY <br />Receivod By; <br />Zoning Validation <br />D~t¢: _ <br /> <br /> UUON co rr se c toN <br /> <br /> - 4:30 I,m Photo. 588-$147 <br />Cod~-A-I'hone ~g8,7904 <br /> FAX 565-7948 <br /> <br />EVALUATION AND/OR ,~ffJq~lC PERMIT APPLICATION' <br /> <br />.......... " l'a'"iU~8 Ada~,,s c l"ho ne N~. <br />DEQ Li~n~d C.o n tr,',',',',',',','~ ~ r & NO. MaillalI A.dd~*l: Pbo~ No. <br /> <br /> $ V~ Bra u~ 0n~ first 1000 v.,~l_ DSF 245100 g0~ ,~ <br /> S~ ~ ~aluat~~$ , 75.~ ~: <br /> C~ping Fill 41S~0 10,00 <br /> Steep Slop~ 245.~ 10~ <br /> <br />~(~o~ ~h ~,a~ ~oo ~. ~, ~s.~ .~ ...... <br /> <br /> R~pair, Minor 75~ .1~ ....... <br /> ~istgg Sys~m Eva~i~ R~ i~ 10.00 <br /> <br />~m~0fi~tio~ N~tlcc ~ Field Visli) 7 ~ 85~0 10.~ <br /> <br />(..M~k if Applicable tO this Appllcatloa) <br />(~ T, s1 Holca ar~ Dug <br /> <br />) Tho work will bc pc~'otcaed by a DEQ Licua~ In~aller <br /> <br />l~ealdentialSzn~le ~'amdv <br />G~Y W~ ~ 120,00 10,00 <br /> <br /> Total <br /> Rocoi~ No, <br />! agl~ ~ inshsll ~cogdJnlg ~ the ~b~d pl~s ~04 specifications, the laws <br />o~o ~ of O~goa and the o~in~ccs of~fioa <br /> <br />N~ OF ~P~i~ (pl~a~ print): <br /> <br />MC 15-$I REV 2193 <br /> <br /> <br />