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«xti � 1'a1fi ,w,ia�'Xttr4h' ,
OFFMIAAG, [1Ui31NE$S
SENDER INSTRU rIONFr �
!Vrtrc�yieurndnrbasVd„y�s�6�si%Il�,t;gde :rc�C3 � : ;1 �+.�,,.w�, „�,,
ke Lrye pplfca hsltitilt. ” • _� �. rt,aws
• 1:JWnplet's HOW,I 2, �, dfid 4 ae the i I{� �, "{ u�"lt ►i�
"knae,
Al
tnoh to lmht o1 0.#Ible U 6010 ° �h
permlte, othemlee ritpx t0 beak of q
orticle�
FAdn►ae m►tlole '•iieturn Rocpipt ,"i ' OWL'iY� FOR PAIVA` g
f#sptle+tad � .ntlyr6ent #it rftin�berr_,
990 Use', 0,300
'TodEiall tPl print Seedor'eHomo., o� ddr sip, j odd tri the specu buipw,
t;(,,U d7'`1f of slt`1"Sr
1,•
Can�p1�'�atA 1 bid 2 i4�hpr► ��
Autaur. 4drolla indritt6andl dervlcaa are ddaira ;h"" "'"^'�--»Y• «..
cdt fibro els tEid'�REtllRtdgIAe�Ge A di d aomAlgtO f e
fot ,adtd yal,.r �i �'�re�f�egr�b eldq, Failurd to de dila wilt c' r
r h ear ar stt ona Ing C
ARI a t d nhr d of pk W n
1 � ana ax a9 forore odd a a �v A aary cua aro avo e d
'„�° V ohi del Brad A. 01 iWNloa(al raquaatad, e, Ova
,. • dxv, dltd bddrdaaara'a m POO,t►rlaetor-
Artiota Addraoaed to: (F / ddredu, - 0 'hddttictod ,jelly
(F3�rxt char�e;l i
4: Artiala Numb14.
��;' '
1' a of Bervico, -..+
' ALc� �C r., 4 ooh• fir. � r L'TCnrrulad L7 dOurad
j'
9C � x . -7 k��je�aa Mall Rat �-n RactV�t
tri c a- a ,� ,, f AlW ' ...... for 014, e_a
6, SI +�-=--.-. r "`` AYa bbfmin algnalirra al add4saedN'
tkl t 41mow-+ Oragant dod D� DE1_,_, i RE7yi
,,,r� 8, Addra
W asda's VO , �Addreas (0%
r9nat Iq . Agent� rrgtres ed rpt fet pfd)
7 Qua of Delivery
001;r►i 3811
a 1%tftr, i.98 ,k 'ILt..C9..i� t7� 19 8
tis 13AftlF. TIL "E111RIV �I CEIP1'
6
t ; I'�-1 0.d'3,-1 (L.Upky teveh Rakich Ch'' I st,:l > ri. Pei l*-, I ')
8Ub
joct tam tho fa I tOW l n§ ootid I t Ions
I.,
Mo*,et the: ete cjU,11,t Otnehts Of the jda t, If 6 i,ft 1 a, bep,'artmdht o°f
for' i tit 61, n sect 1 o Imps rVemehtsl' iNeat°Rodd.
ort4y I oh
ar►aooI
I
''.
I"repare a storm dry 1 nage p l ah to the,appt oVa p of l§utte
cuht t�epak�mettit of 11rr Norlt aha Ihstallaol1lIea
C pub
pr I ar t6 I ssuaince. of the Ua01 Germ I it ►
3 �
Ob td I'M bU I I d i M.0 OOM t!§ f,rOO the �� >�ut,te CIbuht�y E5 h. 'O I hg
(hspedtroil'beipartmcht Id ancordahod WIth baht Gouhty 06de
Sect I aha the Uri I form Sul I ii't'o Core ged I ori ad
i
Irlsfral f a; �riraso t''r�p to preVd,ht1 surfa rr n.off'' feom tho,
Or, k, 1, hg area carry � h� 0 I 1 utah,t;� I t"if:o the �IC±hµtiv stir!
I r,termItt ht' a'ireat» r p , VA 14ii,r6+ i. r Wilk 4+
'i
t t of Pu
Ipgratle O Ne .oyyaa to, f:he Ctepmrtmeh. b 1 I Word a
Otahaards Nc, �? +�'� r i
8 .
ttibt t;ies�prteon-'atto h: ttd meyp'
standard. 1,��''�b r'at�►►�t �r��� ,
Ai ih�resstegress to the pl+r�jept etre steal I 'he I iltittecl to
"
PAY a X50 + iia era 1 I I t7s,cc r I ah' feed the cit i:euhy
ep irtMeht of 13u I J,a t h� I n f ;.ect I ren to t hspect the 'bU I t din'
t, q, ddtp0IM 1 tie, the beds I c✓ I titer I,ty ,cf the bu IA d1h0' "a'ricl 1, f shy
f' hatletivac`I es ek I st,
J..
ibndr,edat'loh shat 1 be I lMlted to 25c menibe!ls.,�
1;t7.
A I I Watdr sUtSp I aril Water qua I 1 ty requ i r'emeri't! ' ref rho
uttd cau, ty Nb'1 d lied I'th Odoaetfthti, bUtt,ei 66Ut-V FJ
'bepaw tmerit /Ck:Ir 1 a - 6 1 V I s I on of P'6eeatIry � I' 1 re
P�1 11 oterc,t hdh fi and the State, ca l I i t�i"h I a ' a# ' be I h' 1 M- +ate~w
Act i us,t be hrie't
I'.1
contact the t tiitte ci txhty I�cis'JUlf td Abd{ emeht' I' tr 1'ct 6,hd
pay t,hc h,6cossary, foes and co6ts tc surVey the' ar'da fc r
mosgOiJ tbs° and e't (ti'l hate breed i h al°tae, as recomlherh ed t y
butt- ddumtyis gii t: o; Abat6mdhrt ,Or 16e t10 o+~cupa'hcy of the
churchi
t
t 6thoe a I I cab e. tt a.,t
App t I cant, must a t std ccmt� t y w t h a I( c he I e
hod Y;oca l' tatCti�es o or' I tiahbe r air � re il�1 at t qhs
...,:,.,r��.",�1
p�,� ';
x� ��}�, ,
u
T{� 1
pY'.,�1V �✓ .�. �l:.iLV L"J-i:✓LV �1'►.7.'1 .i. l�#.J`.L"A �.s.L '�i ,. ".
!�
(EX�iaaiatio►s of all r�y5�t au1d, '�1A�'Efr answers are rdquired on attached,sheet(s�.
�.�
$C�RTFFi 4tiil the proposal result in signiifidant,
lf'S ., MAYBE Np
a, Unstable earth conditiont or char as in , pOld'id'substrUe(ites
g g
i
b. UisruptiorF, displacement, oompt�ei.ion;'` or oVercovaxin of the.i#o
; g ih
e: Change in t9pogr6phy or ground stiri:aee relief °featukes'J
iii Uesa'truction) covering or modii i,catlon of Oy1 unique geologic or'; physica:
• -
featured.
d or wager erasiari of sails,, . ichor." on or bffs
e. lndreate I'm win a itiez
flChangds' in ddpositiou or, erdsi.on of 'boaati sands, or changes in 'ei.Witiao',
deposition or erosion Mhidh icy modify ttia c:hai�tel of a 'river OK' stream
,.
or the bed of the odeahlor at ba � inlet ov lakel
. Loss oftimd a`ridulturall radurt ve "soifi; outside designated ;urban
y '�!. _ g
areaa7
h.Eatpotutd of, people or property to gebio'ia liazardd sueiias, earthquakesi
failure
laridsiide y. mudslides, ground, be aimilar hazardt7
2:
YR. ��ill the ro n;a1 kwat in I�
� p � stmtantlal 3
ai Air emiss' bno or deterioration; of ambient Alt quaj;,i.tyY
�
aoQb edtlonabla odorsymkd pifumts7Yi xha ereian
i.....
i Alteration of air movement mo3.etur e art C
ear Y.eln urd or
u rat � � Y � t�ge.
Climate looall or rb ionall,?
� Y g y
. '..
Wili the proposal result in substan'tia;.
qi Changes it Currents, or; tiia cours0 or t'llydctidn of Water .mo'volonts in,
either aiarihe br .°rests Waters"f
b. CMgos in absorption rands) dkainago'PMtterir-O or the rnte and amount
of ur�a.ce rtit101'i•,7
. .� ,;
.ri Needtot tiff -site surfada draihagd, improvemdnto, including vegeratiotl -
VOL or cu%Vtitrt Installation?
d+ Alta rations to the eourdd or xinwof flood witers!
�• � 1�,
e. ChrangaiY► the atnotint iif' surfado wit , iit any water body7`
bisehatge, into surface Maters, or in any alt;eratioh of turfadd Mater
quality, ine]uding� but ,not limited 6 t:e>ripotatuxt y dis died oxygen or,
.
tukbi.dity
gY Alt xation of tkse direcf«ion or rate of f1nw of ground wators7
66"
iii Change ig 'tiid tiantit" q W1.atero, eithoi+ ttii'taugti
iof dxdM s, orfth oUg1
dlri?dt a ditidns or wit intardoptian of an aquifer
by cuts or eatdaVtiarld�'
+
i r Redudtiort in t�:e ambtuit of Ma1;ek otlieYl��ise 'avai !aisle for publid Watdr
supplies?
u
E posture of peopl'o or pxtlperty td wdtek�rdlat.ud hatards eudh 6s fioddirg!
r+.
FtihAf9C l l W; 11 thepropdaai, re Wit In siibsbkfttiai:
a,Change in this dlVertity of gpeeics� or t►uAde of Wjy i;pedit�S of plants;
(inaluding trees) shrubs; grass; t:roFSsy and agtiai:i plani;sy7
`
b4 pedUcti,on if the nuMbdrd. df any Wiigtten make or ehdange". specie df
plentv3�
ir.w:.:i ✓•
ca incrodudtion' Qin hew spedies of, planta. lhta Ari dreg; ox in a laakrldr tc
fico trOt'fia"L replen;�stimen f existing speaieaT
d', Redutibrs ,fiat.'adkeejid ef' ttf13+ agricultural drop?
77
i,
Will, the pttapasit result in Ub t,tantial':
a. cbange in the divdrsity of spodidsj'nr nwnbers of any, spedibs of animals`
(UH6) land ttni'r»ai ina�litdinl rdptilosf fish and shaiif3shj arganisms
or,ingeets)l
h� Red6dtibft bx the ntw Leta of dny unique, rare or ondangergdd'bdatja oE'
antnals� .
>
t. ltitraduotian df tiewpoies of aniznais ihta an arda, or h a barrier to
the wgration br' movemont of haiw lal
d. lxtodorotioftt t5£ etiating fish ar wiidiiEd :Habitat?
64 Will they prapodai ,resuit. 4tt nub�t4ntia I
&* xni reado in existing route letvdis7
A?, Fxpasurl§. of peopia to It0br- a noise ldvei,'s?
7's tfdf t AM GURt" Wi, 't , Old prop,didl prad'udt} Ai; riii idar►t li ft and g '"lare7
wvs tl� pa°� "osai result in a su�iittantial aitex�atioh of the
8. i Seht Ur Wlrllritldd7elandp-
!t s,, of an At.,
�k aAt?Ft &V'9buRdgs+ hili Itho prop#sai ra,bult ins subst aiait
a. xnoi"dasd i»the rata of use of any ftatuzal 'rx+saiirods?
,W
fe letion.of ah hbn. re
P y ri�t�abiti natu al rosb
lOr AXItt OF tl yip. Wil , the proposal involves
it. A visit of expl6di6h or relearn# of hatardous' su'bktahoas t tidluditi y but
not; limitedto, ttiil y pesticid b dtidmioals or radii ada) ,in tha: dvent
of ah aacid'ent or upset ooYiditions7
1r%'
�.�.
bw p'oasible ihtdeferende with an Bomar osiay kdsp,anse k+la►t emergbnd r
or
evaociatian; pian? ,
�,..,�,�
j
� (3PITLA`lI(iNWill thn' propbttaf aitoillocations distribWhbn, dwidit:y or
grouts rata of, the hwaft populatibft7
0 affd
1�Lr ftottS`i1Vtl. tJii1 the prqobal, p affil g dMittin houdings or oeatd a demand
for additional. hotiallig7
1 RAtt pUR2A7igN/CxRCtP ATI�itV. Will lie ptopasa rosuiir in:
o'� �erieratian'df substantial addi;tiotiaiehielt, tno�lainent?
trektrts on-esigtiht Paxt(ing [acilitries, or ddmand far ndw parkW!,'
t: guftt3t`.tuii:ial: ilnpatrt obi dXiriting trans�ortationsystoms7
d gtgriifibanf #ltdratians tb irrootlrtti ntstt~rk►s of tdiidulation or
inov m nt of, 0 4ie andJor gdads'l
e Al.terdtiotlst:o Watdtbdtid; rail or air traf,fief
i Y.ttiG�1?, tiaf d
y hazAtdk td tllatbe Veiit� Or p6Cield.+ki 1�7
los Ll;Y.IC sLftVIC)?i'r IViil' theiYapbsdir haVd an e,fieot upot� or rosuit in a ned
forndw or aito'dd govdi'nhtdri:'t serviuest
av t<ika proteb' .16 it
bp' polices oteGtibrtl
J
�oHoais7
tsaxks or ather
taaihti�nandd' of , ttblid facilitiesThai
p _ udidgtsadri`t
.:
t,, L%`.
f,, Either go+rernmenta. sei icd;?
t�
l }
I
t"JiI�C tha prctpbaal fdault tli
"
b' S�stfrtantit intr a iii dcinaiia upGn e:Xiatiq Gaureda of +anergy,. br
qu rb u.4cievdlapmoj)t di :ha,4 gbu,rada, of nttrgy?
, ..
i.
1�,3iie ptd'pdaai tdault ity artedd fpr neer eyatbrd3 er
dubatant ialt 4heratio t to the, f al. Ewing t
pdva br natural eda7
1.YM ._
b� Cametlnibat�ona tl�+�t7' .
_
ei a vor saptid, ay toms?
r.
StOrM. i+a .er drainal a
.�..w:,
'Sbi,d i"aatF� attd aiapaaai�
-
17«
ttt"fAN..iimm.: Will Old. prdpaaal 4e'tt�,t tit
a ce'eiiti0o Ot ahy 1jo4ltitt ituat+d Or potdtttisdl hazdrd eudludin9 ment:al
health
b" i:x nat�r�d d> eo ld td phtbntial hed,lth ha�ar'dn7
Be
AZrSTitt`i'f h prepoed.l idwit< .in tite obg%rudt�i.an b� 'a", �n mid
Will tine
'viate or ribw apen tb thb ubliby de wild:. thb pf'd d�+ul; rbaul it tilts
d 1Yli.it Vid�tl
ui' �ri �b:��tdt3ebl� � b��bnnik'Vb ai,te b brt p
lir
L�CPYA'rMN' Wilt the°' pi~ajpb' a1 YrsN► i t iri.:grt. imp. bt upu thbquality dt
uunti,>r of btkla iti �'@4�YP.A ti�ina� 6PPW
�� �
fi7i'1't1RA�� �Z~ StltfiiC$$.
i> All �M pt'dpdaal' result ill thea al lwAtfgtt ur deaktddtidtt Of a
pieiates�"c ur k�l�dtbrirt iarbYtddiadd aitid7
b" Wi.l . the ptapoaaI result ih adtvbna phygln41 nr Aeotitdtid' efiebta
to d preiti'srdrib at hiatdt;id Wilding) strtictrxzd b dwod
bads tltd prdp,664 MWO, the pAbittial to daut'd a pityaleal ehw 6
whl dh wvaui fdtt uhiqu4 ethyl d bultuta.l V41udal
d Wi11tha, pfbpbaa '. reste d.t dxt stip ' 'ti;ihibita Or abdred uaaa withir't
�
Ttid ptlt;bttL•3a1 impaCti �it`dd'I
�e� attavi�dd y
"
71
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no acti
!fir at boodt ii i tiq rYnit ti)
Fit t do fto h the city d
tiOff to t,
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e fatwit,PubI46 Road (O Y, 'Clark lark ytoo ( tat6
a bia Emil l j {� u so j y �{
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