20240697 Ver 1_More Info Received_20240708 (2)

DREDGE SPOIL DISPOSAL FORM
Project Name/address: -,�3b5"V} 7T44( VITA. ✓Ik-V Cie- County: J1- AyQK -
Location Address: Cv?4 o Y✓t, oVILL- jZi] J)-e� ut.2 LJC .28037
Parcel M &A 4a 2_ 12 -7?
Parcel/lot size &cnsi Z E' 75" A--tf S
Disposal area required (sq ft and/or acreage) r' /4Grez
Acknowledgement of Notification
I, SAWaL4,0C am aware that the site must adhere to all state regulations
and rules regarding sediment and erosion control and water quality. And give permission for
Name of Individual and Compa
to dispose of their dredge material at the above stated location
Owner: 3 Am uzL L Gami>'ssri!
Print
Date:
Along with form, please provide:
Aerial of parcel/lot (County GIS)
Photo of proposed spoil site
Identified proposed spoil site
re