GENERAL37049

• Permit No: M1988112
• IBM Index Class Name: General Documents
• Doc Date: 10/4/1984
• From: DWR
• Media Type: D
• Archive: No

NAME , NJ. * , DN. , DIST.
SPACE AR~VE li~R DNISIDN OF WATFR RESJLIItCFS USE ONLY
NOTICE OF INII~NP 10 WNSTRUGT A NJN~T[IItISDICTIDNAL ~
(Must be submitted to the Division Engineer 10 days prior to construction)
OWNER INFORMATION
Name
Address
Street, P.O. FJOx, Rural Route
City State ZIP Code
Telephone
Area Code
Responsible Person
Address
Street, City State ZIP Code
S'II2UCT[ktE INFORMATION
'" e , DN. , DIST.
Location: Qtr. Sect. _, Sect. Twnshp. Range , P.N..
Height ft., Length Et., Slopes: U/S D/S
Capacity
Spillway Width
Outlet Type
A.F., Drainage Area
ft., Freeboard
Size
DNISION ENGII~S REMARKS
Acres
ft.,
Inches
Signature
Approval Recarm~ended• YES DD _
Division Engineer's Signature
f Vertical height less than 10 feet at longitudinal centerline of dam from lowest point
of ground surface to flowline crest of spillway, or 20 surface acres or less at high
water Line, or impounds 100 acre-feet or less of water.
* To create an index of structures.