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�1 <br /> r -� <br /> 9t ' Lint of all Pcrml[s, i.icenses or Covcrnment Approvals Requlred foc thc Propos�l (tedcral , <br /> c:o[c and. local--ineludi�ezones): Building Permit - � <br /> ' Draina e Permi - <br /> 10. Do you havc any plans Eor [uture additions, expansion, or furthcr activity rclated to or � <br /> eonnected vi[h this proposal? If yes� explain: No � <br /> . 11. Do you knou oE any plans by others Which may affect the property covered by your propusa]' <br /> If yes, explain: No <br /> � <br /> 12. Actach any o[her application form that has been comple[ed regarding the proposal; ,if none <br /> has been co:npleied, but is expected to be filed at some future date, describe the nature <br /> of such application form: None <br /> II. EATIRO�^�!�'tAL L*tPACTS ' <br /> (Explanations of all "yes and "maybe" answers are required) <br /> . . Yes ?iaybe i�o <br /> (1) Ear[h. t2i11 the proposal result in• Z <br /> (a) Unstable earth conditions or in changes in geologic subs[ructuresl _ _ <br /> X <br /> (b) Disruptions, �li.splace�r.en[s, compaction or overcovering of [he soi17 _ _. X <br /> (c) Change in topography or ground surface relief features? _— — — <br /> , (d) The destruction, covc�ring or modification of any un[que geologic • x <br /> or physiral features4 — '— <br /> (e) Any Sncrease in vind or water eroaion of soils, either on or — X <br /> off the siteY — <br /> (f) Cliar,ges in deposition or erosion oE beach sands, or changes in <br /> siltation, deposition or erosion which may roodify [he channel of <br /> a rlver or s[re:�.m or the bed of the ocean or any bay, inlet or X <br /> � lakel -- — — <br /> Exolanation: <br /> (2) Airt h'ill the proposal result in: <br /> (a) Air emissions or deterioratian of ambient air quality4 �. — <br /> X <br /> X <br /> (b) Yhe creation of objectionable odorsl — ,— — <br /> (c) A1[cration of air movement, moisture or temperaturc, or any x <br /> change In climate, either locally or regionally? � — — I <br /> . E�+lanation: --J <br /> (3) 6'ater. 17i11 the propnsal resull in: � , <br /> (n) ClianePs in currmits, or the course or direction of NACCT _y X <br /> . movcments, in eithcr m�rine nr [resli wotcrs? � -.— <br /> I_ . � • <br />