REQUEST FOR DETERMINATION OF APPLICABILITY FILING HISTORY
| Street Address: | Local File No.: | |||
| Map and lot: | Subdivision Lot No.: | Book and Page: | ||
| RFD Date: | Meeting Date: | RFD Date: | ||
| Type of work: | ||||
List applicant, owner, representatives
| Role | Name | Phone | Address |
Plan references (Include original subdivision plan if available)
| Date | Title, Scale, Revisions, Remarks. |
Attachments (Erosion and Sedimentation Plan, Replication Plan, etc.)
| Date | Description |
Meetings and site walks:
| Date | Description |
Summary of Nonstandard Conditions and Followup Needed
| Date | Description |
Attach further sheets as needed for additional chronology, list of correspondence, etc.