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: Lint of nll Permits, i.icens�� or Covernment A�i'•rovals Requir�d tor thc P'oposal (E����� <br />cones) : �� C/� O� �V� <br />Ty" iG��� 3—� <br />etate nnd loc�l--including , ��.--- ������� _ <br />.fir ,PEqo Z/4t �4G WlT/� �E — <br />10. Do you have any plana•Eor F�ture adeitiexplainP,nsion, or further activity rclatc to 0 <br />connec[ed With thie proposal4 If Y e+ ��� ^' 'N"k/� pPn��� �N Tf�� <br />11. Do you know of nnY <br />If yes, explain:_ <br />5 N ,�%U ulA/ AT �s �����• <br />ert covered 6y your propoea]'. <br />by others which may affect the prop Y —_ <br />licntion form thnt has been comFleted regatding the proposal; if noua <br />12, Attach any other app O� �� l,������ <br />has been completed, but is expevLt�� o�� 1e���D f� u�;� describe the na ur <br />of such application form: _�_ <br />11iVi� G240iN�—P�',eM/T AOPC/ 7� — <br />ENVIR02R1ErTAL I'�ACTS �� es and "muybe" answers nre required) <br />(Explanations of all y <br />(1) <br />Yes Tfavbe 1�.� <br />Earth. �dill the proposal result in: ' _ � <br />(a) Unstable earch conditions or in changes in geologic substructures? _ <br />(b) Disruptions, displacements, compaction or overcovering of the soil? � <br />(c) Change in topoSraphy ot grwnd surface relief features? = <br />(d) The deseruction, covc�ring or modification of any untque geologic <br />or physical features? , either on or <br />(e) pny increase in wind or water erosion of soils, _ <br />off the site? <br />(f) Changes in deposition or etosion of beach sands, °thehchannel of <br />siltation, deposition or erosion which may modify�a inlet or � <br />a ri��er or stteam or the bed of the ocean or any Y, <br />lake? --� ,,.... ...�i<rOiYYIM/ G� �R B[ <br />Dcpla.� a[=°°' <br />�' ��G 8E CAV <br />SlDl.M' UJQ7EL W <br />(Z) Air. ldill the propusal result in: <br />PiGiNG SVS7&'M <br />(8) pir emissions or deterioration of ambient air qualityY <br />(b) The creation of objectionable odors? <br />(�) Alteration of air movement, moisture or temperature, or any <br />chnnge in climate, eieher locally or tegionally? <br />Explanntion: <br />(3) Nater. Will thc proposal result in: <br />(8) C��anr,Ps in in eit cr m:irine or ft�sli u�t T?°n of Water <br />movemenCs, <br />X � <br />7HE P,9KCEG. <br />� � � <br />� � � <br />� _ X <br />X.�— ..— <br />r' <br />