ࡱ > bjbjVV < < @
S S S S S \ + o \! ( " # P p* r* r* r* r* r* r* $ , '/ z * S p# \! \! p# p# * S S G+ $ $ $ p# F S S p* $ p# p* $ $ : ( , ) qi # R $)
\* ]+ 0 + .) R / $ / ) / S ) p# p# $ p# p# p# p# p# * * $ p# p# p# + p# p# p# p# / p# p# p# p# p# p# p# p# p# : J O I N T A P P L I C A T I O N F O R M F O R I L L I N O I S I T E M S 1 A N D 2 F O R A G E N C Y U S E 1 . A p p l i c a t i o n N u m b e r 2 . D a t e R e c e i v e d 3 . a n d 4 . ( S E E S P E C I A L I N S T R U C T I O N S ) N A M E , M A I L I N G A D D R E S S A N D T E L E P H O N E N U M B E R S 3 a . A p p l i c a n t s N a m e
F O R M T E X T
C o m p a n y N a m e ( i f a n y )
F O R M T E X T
A d d r e s s
F O R M T E X T
E m a i l A d d r e s s
F O R M T E X T 3 b . C o - A p p l i c a n t / P r o p e r t y O w n e r N a m e
( i f n e e d e d o r i f d i f f e r e n t f r o m a p p l i c a n t )
F O R M T E X T
C o m p a n y N a m e ( i f a n y )
F O R M T E X T
A d d r e s s
F O R M T E X T
E m a i l A d d r e s s
F O R M T E X T 4 . A u t h o r i z e d A g e n t ( a n a g e n t i s n o t r e q u i r e d )
F O R M T E X T
C o m p a n y N a m e ( i f a n y )
F O R M T E X T
A d d r e s s
F O R M T E X T
E m a i l A d d r e s s
F O R M T E X T A p p l i c a n t s P h o n e N o s . w / a r e a c o d e
B u s i n e s s : F O R M T E X T
R e s i d e n c e : F O R M T E X T
C e l l : F O R M T E X T
F a x : F O R M T E X T
A p p l i c a n t s P h o n e N o s . w / a r e a c o d e
B u s i n e s s : F O R M T E X T
R e s i d e n c e : F O R M T E X T
C e l l : F O R M T E X T
F a x : F O R M T E X T A g e n t s P h o n e N o s . w / a r e a c o d e
B u s i n e s s : F O R M T E X T
R e s i d e n c e : F O R M T E X T
C e l l : F O R M T E X T
F a x : F O R M T E X T S T A T E M E N T O F A U T H O R I Z A T I O N
I h e r e b y a u t h o r i z e , F O R M T E X T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ t o a c t i n m y b e h a l f as my agent in the processing of this application and to furnish, upon request, supplemental information in support of this permit application.
_____________________________________________________ ___________________________________________
Applicants Signature Date5. ADJOINING PROPERTY OWNERS (Upstream and Downstream of the water body and within Visual Re a c h o f P r o j e c t ) N a m e
a . F O R M T E X T
b . F O R M T E X T
c . F O R M T E X T
d . F O R M T E X T M a i l i n g A d d r e s s
F O R M T E X T
F O R M T E X T
F O R M T E X T
F O R M T E X T P h o n e N o . w / a r e a c o d e
F O R M T E X T
F O R M T E X T
F O R M T E X T
F O R M T E X T 6 . P R O J E C T T I T L E :
F O R M T E X T 7 . P R O J E C T L O C A T I O N
L A T I T U D E : F O R M T E X T
L O N G I T U D E : F O R M T E X T
U T M s
N o r t h i n g : F O R M T E X T
E a s t i n g : F O R M T E X T S T R E E T , R O A D , O R O T H E R D E S C R I P T I V E L O C A T I O N
F O R M T E X T L E G A L
D E S C R I P T
Q U A R T E R
F O R M T E X T S E C T I O N
F O R M T E X T T O W N S H I P N O .
F O R M T E X T R A N G E
F O R M T E X T F O R M C H E C K B O X I N O R F O R M C H E C K B O X N E A R C I T Y O F T O W N ( c h e c k a p p r o p r i a t e b o x )
M u n i c i p a l i t y N a m e
F O R M T E X T W A T E R W A Y
F O R M T E X T R I V E R M I L E
( i f a p p l i c a b l e )
F O R M T E X T C O U N T Y
F O R M T E X T S T A T E
F O R M T E X T Z I P C O D E
F O R M T E X T R e v i s e d 2 0 1 0
F O R M C H E C K B O X C o r p s o f E n g i n e e r s
F O R M C H E C K B O X I L D e p t o f N a t u r a l R e s o u r c e s
F O R M C H E C K B O X I L E n v i r o n m e n t a l P r o t e c t i o n A g e n c y
F O R M C H E C K B O X A p p l i c a n t s C o p y 8 . P R O J E C T D E S C R I P T I O N ( I n c l u d e a l l f e a t u r e s ) : F O R M T E X T
9 . P U R P O S E A N D N E E D O F P R O J E C T : F O R M T E X T
C O M P L E T E T H E F O L L O W I N G F O U R B L O C K S I F D R E D G E D A N D / O R F I L L M A T E R I A L I S T O B E D I S C H A R G E D 1 0 . R E A S O N ( S ) F O R D I S C H A R G E : F O R M T E X T
1 1 . T Y P E ( S ) O F M A T E R I A L B E I N G D I S C H A R G E D A N D T H E A M O U N T O F E A C H T Y P E I N C U B I C Y A R D S F O R W A T E R W A Y S :
T Y P E : F O R M T E X T
A M O U N T I N C U B I C Y A R D S : F O R M T E X T
1 2 . S U R F A C E A R E A I N A C R E S O F W E T L A N D S O R O T H E R W A T E R S F I L L E D ( S e e I n s t r u c t i o n s )
F O R M T E X T 1 3 . D E S C R I P T I O N O F A V O I D A N C E , M I N I M I Z A T I O N A N D C O M P E N S A T I O N ( S e e , 6 F H J ~ ·¬weLD hYl CJ ^J 0j hVh hYl CJ OJ QJ U^J mH nH u #j hVh hYl CJ U^J hVh hYl CJ ^J j hVh hYl CJ U^J hYl CJ ^J hVh hYl CJ ^J h OJ QJ hVh h CJ ^J hVh hxc CJ ^J hxc OJ QJ h EHOJ QJ ^J hVh hVh EHOJ QJ ^J hVh hxc EHOJ QJ ^J h
EHOJ QJ ^J H J $$If a$ c kd $$If s + + 0 + 4
s as ytG9 $If gd $If f kd $$If s 4 v + + 0 + 4
s as f4ytG9 ~ $If v kdJ $$If s 0 /+ / 0 + 4
s as ytG9 ~
*
:
b
~
H p $If gd{jj f kd, $$If s 4 + + 0 + 4
s as f4ytG9
&
(
*
:
<
P
R
T
^
`
b
~
ϽڤڜςڤqdPq 'j0 hVh hYl CJ U^J aJ hVh hYl CJ ^J aJ !j hVh hYl CJ U^J aJ #j hVh hYl CJ U^J hYl CJ ^J hYl CJ ^J 0j hVh hYl CJ OJ QJ U^J mH nH u #jH hVh hYl CJ U^J hVh hYl CJ ^J j hVh hYl CJ U^J hYl CJ ^J aJ hVh hYl CJ ^J aJ
F H J ^ ` b l n p ~ ɲ|tg]K|tɲ #j hVh hYl CJ U^J hYl CJ ^J aJ hVh hYl CJ ^J aJ hYl CJ ^J 0j hVh hYl CJ OJ QJ U^J mH nH u #j hVh hYl CJ U^J hVh hYl CJ ^J j hVh hYl CJ U^J hYl CJ ^J hVh hYl CJ ^J !j hVh hYl CJ U^J aJ 4j hVh hYl CJ OJ QJ U^J aJ mH nH u 0 2 4 > @ B {`XM; #jt hVh hYl CJ U^J hVh hYl CJ ^J hYl CJ ^J 4j hVh hYl CJ OJ QJ U^J aJ mH nH u 'j hVh hYl CJ U^J aJ hVh hYl CJ ^J aJ !j hVh hYl CJ U^J aJ hVh hYl CJ ^J aJ hVh hYl CJ ^J 0j hVh hYl CJ OJ QJ U^J mH nH u j hVh hYl CJ U^J #j hVh hYl CJ U^J B
.
V
r
l kdD $$If s .F +
0 + 4
s as ytG9 $If gd{jj
.
0
D
F
H
R
T
V
r
t
ǵҜҜґnaMn 'j hVh hYl CJ U^J aJ hVh hYl CJ ^J aJ !j hVh hYl CJ U^J aJ #j\ hVh hYl CJ U^J hVh hYl CJ ^J 0j hVh hYl CJ OJ QJ U^J mH nH u #j hVh hYl CJ U^J hVh hYl CJ ^J j hVh hYl CJ U^J hYl CJ ^J aJ hVh hYl CJ ^J aJ hYl CJ ^J
4 6 J L N X Z h j ~ |aMa 'j hYl h CJ U^J aJ 4j hYl h CJ OJ QJ U^J aJ mH nH u 'j hYl h CJ U^J aJ !j hYl h CJ U^J aJ hYl h CJ ^J aJ hVh h CJ ^J h CJ ^J hYl OJ QJ hVh hYl CJ ^J !j hVh hYl CJ U^J aJ 4j hVh hYl CJ OJ QJ U^J aJ mH nH u
\
F * f
dh $If gd7D ~
4 6 8 B D \ ^ r t v ڿڲڲڿڔvڲbڿڲڲNڿڲ 'jV hYl h CJ U^J aJ 'j
hYl h CJ U^J aJ hVh h CJ ^J h CJ ^J hVh h{jj CJ ^J h CJ ^J aJ 'jn
hYl h CJ U^J aJ hYl h CJ ^J aJ 4j hYl h CJ OJ QJ U^J aJ mH nH u !j hYl h CJ U^J aJ 'j hYl h CJ U^J aJ ( * > @ T V X b d | ~ wc 'j&
hYl h CJ U^J aJ 'j hYl h CJ U^J aJ h CJ ^J hVh h CJ ^J 'j> hYl h CJ U^J aJ 4j hYl h CJ OJ QJ U^J aJ mH nH u 'j hYl h CJ U^J aJ hYl h CJ ^J aJ !j hYl h CJ U^J aJ !
B D n p ڿڲڲڿړ}um^SA^ #j hVh h_ CJ U^J hVh h_ CJ ^J j hVh h_ CJ U^J h\ CJ ^J h\ OJ QJ h\ h\ 56CJ ^J h OJ QJ hVh h CJ ^J 'j hYl h CJ U^J aJ hYl h CJ ^J aJ 4j hYl h CJ OJ QJ U^J aJ mH nH u !j hYl h CJ U^J aJ 'j
hYl h CJ U^J aJ
B u i $$If a$gd{jj kd $$If s F +
0 + 4
s as ytG9 B D F
$If gd{jj c kdP $$If s + + 0 + 4
s as ytG9 " $ . 0 2 4 H J L V reQr6 4j hVh hYl CJ OJ QJ U^J aJ mH nH u 'j hVh hYl CJ U^J aJ hVh hYl CJ ^J aJ !j hVh hYl CJ U^J aJ hYl CJ ^J aJ h7D CJ ^J aJ hYl OJ QJ h CJ ^J aJ h7D CJ ^J aJ hYl hYl CJ ^J aJ h{jj OJ QJ h{jj CJ ^J h\ CJ ^J j hVh h_ CJ U^J 0j hVh h_ CJ OJ QJ U^J mH nH u " $ + c kd
$$If s + + 0 + 4
s as ytG9 d $If gdYl c kdh $$If s + + 0 + 4
s as ytG9 $ . Z , T | H p dh $If gd7D V X Z \ ^ ` b v x z ͊v[ 4j hVh hYl CJ OJ QJ U^J aJ mH nH u 'j hVh hYl CJ U^J aJ 'j hVh hYl CJ U^J aJ 4j hVh hYl CJ OJ QJ U^J aJ mH nH u 'j" hVh hYl CJ U^J aJ hVh hYl CJ ^J aJ h7D CJ ^J aJ hYl CJ ^J aJ !j hVh hYl CJ U^J aJ ( * , . B D F P R T V j l n x z | ~ Ոt` 'j hVh hYl CJ U^J aJ 'jp hVh hYl CJ U^J aJ 'j hVh hYl CJ U^J aJ hYl CJ ^J aJ 4j hVh hYl CJ OJ QJ U^J aJ mH nH u 'j hVh hYl CJ U^J aJ hVh hYl CJ ^J aJ !j hVh hYl CJ U^J aJ hYl hYl CJ ^J aJ " 6 8 : D F H J ^ ` b l n p r t ڿڲڲڿڔڲڿڔڲlڿڲd\Q hVh hVh CJ ^J h0]q CJ ^J hYl OJ QJ 'j hVh hYl CJ U^J aJ 'jH hVh hYl CJ U^J aJ hYl CJ ^J aJ 'j hVh hYl CJ U^J aJ hVh hYl CJ ^J aJ 4j hVh hYl CJ OJ QJ U^J aJ mH nH u !j hVh hYl CJ U^J aJ 'j\ hVh hYl CJ U^J aJ p r u i i d $If gd$ kd4 $$If s dF
+
0 + 4
s as ytG9 ᠘xi^Li #j hVh h_ CJ U^J hVh h_ CJ ^J j hVh h_ CJ U^J h_ CJ ^J h7D OJ QJ h7D CJ ^J hG9 CJ ^J hVh OJ QJ hYl hVh CJ ^J 0j hVh hYl CJ OJ QJ U^J mH nH u #j hVh hYl CJ U^J hVh hYl CJ ^J j hVh hYl CJ U^J hYl CJ ^J hVh CJ ^J + c kd( $$If s x + + 0 + 4
s as yt_ d $If gd7D c kdx $$If s + + 0 + 4
s as ytG9 ( * B D F Z \ ^ h j l z | N P d f h r t ųثЫЫřЫŇmث #j hVh h_ CJ U^J hG9 OJ QJ #j: hVh h_ CJ U^J #j hVh h_ CJ U^J h_ CJ ^J #jN hVh h_ CJ U^J hVh h_ CJ ^J hG9 CJ ^J j hVh h_ CJ U^J 0j hVh h_ CJ OJ QJ U^J mH nH u) , . n p z | N v | v kd $$If s 0 + 0 + 4
s as yt_ d $If gd7D H T | $d $If a$gd_ d $If gd7D " 6 8 : D F T V j l n x z | ~ |teZ hdH h_ CJ ^J j hdH h_ CJ U^J h_ OJ QJ #jj hVh h_ CJ U^J #j hVh h_ CJ U^J #j~ hVh h_ CJ U^J hVh h_ CJ ^J h_ CJ ^J 0j hVh h_ CJ OJ QJ U^J mH nH u j hVh h_ CJ U^J #j hVh h_ CJ U^J | ~ & J r < 0 0 0 d $If gd7D kd $$If s ֈ !w(+ U 0 + 4
s as yt_ J L ` b d n p
˹֪tlZtlHt#j
" hVh h_ CJ U^J #j! hVh h_ CJ U^J h_ CJ ^J 0j hVh h_ CJ OJ QJ U^J mH nH u #j ! hVh h_ CJ U^J hVh h_ CJ ^J j hVh h_ CJ U^J #j hdH h_ CJ U^J hdH h_ CJ ^J h_ CJ ^J j hdH h_ CJ U^J #j6 hdH h_ CJ U^J r F e Y Y d $If gd7D kd" $$If s 4 F $+ `7 ` 0 + 4
s as yt_ $d $If a$gdG9
4 6 8 B D R T h j l v x $ ֙ևtetSet #j^& hdH h.. CJ U^J j hdH h.. CJ U^J hdH h.. CJ ^J h.. CJ ^J #j$ hVh h_ CJ U^J #j $ hVh h_ CJ U^J 0j hVh h_ CJ OJ QJ U^J mH nH u #j# hVh h_ CJ U^J hVh h_ CJ ^J j hVh h_ CJ U^J h_ OJ QJ h_ CJ ^J F R z B kd$ $$If s 4 r $+ 7 0 + 4
s as yt_ d $If gd7D " > 8 : { c kd( $$If s i + + 0 + 4
s al yt#U $d $If a$gdxc d $If gd#U gd.. $ & B D F L N < > @ 坕shVs #j.( hVh h#U CJ U^J hVh h#U CJ ^J j hVh h#U CJ U^J hVh h#U CJ ^J h#U CJ ^J h" CJ ^J h.. CJ OJ QJ #j' hdH h.. CJ U^J #jF' hdH h.. CJ U^J h.. CJ ^J #j& hdH h.. CJ U^J hdH h.. CJ ^J j hdH h.. CJ U^J & ( * 4 6 : < & * ºاЍumcYOE hP CJ ^J aJ hxc CJ ^J aJ h0]q CJ ^J aJ h" CJ ^J aJ h7D OJ QJ h7D CJ ^J aJ h*] h7D 5CJ ^J aJ h#U OJ QJ #jT) hVh h#U CJ U^J hVh h#U CJ ^J h" CJ ^J hxc OJ QJ h*] hxc 5CJ ^J aJ h#U CJ ^J j hVh h#U CJ U^J 0j hVh h#U CJ OJ QJ U^J mH nH u: < ( c kdz* $$If s ^ + + 0 + 4
s al ytx $d $If a$gdxc c kd) $$If s p + + 0 + 4
s al yt#U * , @ B D N P V X \ b * . 0 D F H R T T! V! j! 𰨞n\𰨞 #j, hVh hP CJ U^J #jP, hVh hP CJ U^J hP CJ ^J aJ h CJ ^J aJ h0]q CJ ^J aJ h" CJ ^J aJ hxc OJ QJ hxc CJ ^J aJ 0j hVh hP CJ OJ QJ U^J mH nH u #j*+ hVh hP CJ U^J hVh hP CJ ^J j hVh hP CJ U^J # R T V X V w k k k dh $If gdxc c kd+ $$If s R + + 0 + 4
s al yt d $If gdxc d $If gdVh dh $If gd0]q T! |! d $If gdVh dh $If gd0]q c kd<- $$If s + + 0 + 4
s al yt j! l! n! x! z! |! ~! ! ! ! ! " z z z 4z 6z 8z Bz Dz Fz Hz Jz Lz Pz z z ވvlh`UF j h$ h CJ U^J h$ h CJ ^J h CJ ^J hxc hxc CJ OJ QJ #j./ hVh hP CJ U^J hVh hP CJ ^J Uh
CJ ^J aJ h0]q CJ ^J aJ h" CJ ^J aJ hxc OJ QJ hxc CJ ^J aJ 0j hVh hP CJ OJ QJ U^J mH nH u j hVh hP CJ U^J #j- hVh hP CJ U^J |! ~! z Fz Hz w d $If gdxc d $If gdVh dh $If gd0]q c kdp. $$If s Q + + 0 + 4
s al yt i n s t r u c t i o n s )
F O R M T E X T
1 4 . D a t e a c t i v i t y i s p r o p o s e d t o c o m m e n c e
F O R M T E X T D a t e a c t i v i t y i s e x p e c t e d t o b e c o m p l e t e d
F O R M T E X T 1 5 . I s a n y p o r t i o n o f t h e a c t i v i t y f o r w h i c h a u t h o r i z a t i o n i s s o u g h t n o w c o m p l e t e ? Y e s F O R M C H E C K B O X N o F O R M C H E C K B O X N O T E : I f a n s w e r i s Y E S g i v e r e a s o n s i n t h e P r o j e c t D e s c r i p t i o n a n d R e m a r k s s e c t i o n . M o n t h a n d Y e a r t h e a c t i v i t y w a s c o m p l e t e d F O R M T E X T I n d i c a t e t h e e x i s t i n g w o r k o n d r a w i n g s . 1 6 . L i s t a l l a p p r o v a l s o r c e r t i f i c a t i o n a n d d e n i a l s r e c e i v e d f r o m o t h e r F e d e r a l , i n t e r s t a t e , s t a t e , o r l o c a l a g e n c i e s f o r s t r u c t u r e s , c o n s t r u c t i o n , d i s c h a r g e s o r o t h e r a c t i v i t i e s d e s c r i b e d i n t h i s a p p l i c a t i o n . I s s u i n g A g e n c y T y p e o f A p p r o v a l I d e n t i f i c a t i o n N o . D a t e o f A p p l i c a t i o n D a t e o f A p p r o v a l D a t e o f D e n i a l F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T F O R M T E X T 1 7 . C O N S E N T T O E N T E R P R O P E R T Y L I S T E D I N P A R T 7 A B O V E I S H E R E B Y G R A N T E D . Y e s F O R M T E X T N o F O R M T E X T 1 8 . A P P L I C A T I O N V E R I F I C A T I O N ( S E E S P E C I A L I N S T R U C T I O N S ) A p p l i c a t i o n i s h e r e b y m a d e f o r t h e a c t i v i t i e s d e s c r i b e d h e r e i n . I c e r t i f y t h a t I a m f a m i l i a r w i t h t h e i n f o r m a t i o n c o n t a i n e d i n t h e a p p l i c a t i o n , a n d t h a t t o t h e b e s t o f m y k n o w l e d g e a n d b e l i e f , s u c h i n f o r m a t i o n i s t r u e , c o m p l e t e , a n d a c c u r a t e . I f u r t h e r c e r t i f y t h a t I p o s s e s s t h e a u t h o r i t y t o u n d e r t a k e t h e p r o p o s e d a c t i v i t i e s . F O R M T E X T S i g n a t u r e o f A p p l i c a n t o r A u t h o r i z e d A g e n t D a t e F O R M T E X T S i g n a t u r e o f A p p l i c a n t o r A u t h o r i z e d A g e n t D a t e F O R M T E X T S i g n a t u r e o f A p p l i c a n t o r A u t h o r i z e d A g e n t D a t e F O R M C H E C K B O X C o r p s o f E n g i n e e r s
R e v i s e d 2 0 1 0
F O R M C H E C K B O X I L D e p t o f N a t u r a l R e s o u r c e s
F O R M C H E C K B O X I L E n v i r o n m e n t a l P r o t e c t i o n A g e n c y
F O R M C H E C K B O X A p p l i c a n t s C o p y
S E E I N S T R U C T I O N S F O R A D D R E S S L O C A T I O N M A P
R e v i s e d 2 0 1 0
F O R M C H E C K B O X C o r p s o f E n g i n e e r s
F O R M C H E C K B O X I L D e p t o f N a t u r a l R e s o u r c e s
F O R M C H E C K B O X I L E n v i r o n m e n t a l P r o t e c t i o n A g e n c y
F O R M C H E C K B O X A p p l i c a n t s C o p y
P L A N V I E W
F O R A G E N C Y U S E O N L Y
F O R M T E X T
R e v i s e d 2 0 1 0
F O R M C H E C K B O X C o r p s o f E n g i n e e r s
F O R M C H E C K B O X I L D e p t o f N a t u r a l R e s o u r c e s
F O R M C H E C K B O X I L E n v i r o n m e n t a l P r o t e c t i o n A g e n c y
F O R M C H E C K B O X A p p l i c a n t s C o p y
Hz Jz Lz z z { F{ $If c kd/ $$If s w + + 0 + 4
s al yt7D z z z z z z z { { 4{ 6{ 8{ B{ D{ F{ H{ L{ { { { | | | | | "| $| @| ԻԻwh]Khwwh] #j82 h$ h*] CJ U^J h$ h*] CJ ^J j h$ h*] CJ U^J h$ hVh CJ ^J h$ hVh CJ ^J h0]q CJ ^J h$ h ^J #j0 h$ h CJ U^J h$ h CJ ^J 0j h$ h CJ OJ QJ U^J mH nH u j h$ h CJ U^J #jT0 h$ h CJ U^J h$ h CJ ^J F{ H{ { { | "| F| | $If y kd41 $$If s 4 0 r+ y & 0 + 4
s al f4ytFU @| B| D| F| T| | | H} L} N} P} d} f} h} r} t} v} } } } } } n p > @ B V ӎum`T` h$ hVh >*CJ ^J h$ hVh OJ QJ ^J h0]q CJ ^J 0j h$ hVh CJ OJ QJ U^J mH nH u #j4 h$ hVh CJ U^J j h$ hVh CJ U^J h_ CJ ^J h$ hVh ^J h$ hVh CJ ^J h*] CJ ^J h$ hVh CJ ^J j h$ h*] CJ U^J #j2 h$ h*] CJ U^J | | N} v} } 9 3 3 3 $If kd 3 $$If s 4 gֈ r+ q 0 + 4
s al f4ytx } } n r l $If kdb5 $$If s 4 F +
0 + 4
s al f4ytx n p > $$If a$ $If f kd6 $$If s 4 4 + + 0 + 4
s al f4ytx > @ h 9 3 3 3 3 $If kd27 $$If s 4 ֈ /J &+ T z 0 + 4
s al f4ytx V X Z d f h j ~ Ѐ Ҁ ܀ ހ
" r` #j: h$ hVh CJ U^J #jt: h$ hVh CJ U^J #j9 h$ hVh CJ U^J #j9 h$ hVh CJ U^J #j9 h$ hVh CJ U^J h$ hVh CJ ^J 0j h$ hVh CJ OJ QJ U^J mH nH u j h$ hVh CJ U^J #j8 h$ hVh CJ U^J % 0 2 Z 3 kd`; $$If s 4 ~ ֈ /J &+ T z 0 + 4
s al f4ytx $If " , . 0 2 4 H J L V X Z \ p r t ~ ā Ё ҁ ԁ Ͳ͎͠|j #j> h$ hVh CJ U^J #j> h$ hVh CJ U^J #j= h$ hVh CJ U^J #j4= h$ hVh CJ U^J #j< h$ hVh CJ U^J h$ hVh ^J h$ hVh CJ ^J j h$ hVh CJ U^J 0j h$ hVh CJ OJ QJ U^J mH nH u) ҁ " $ 3 kdv? $$If s 4 Z ֈ /J &+ T z 0 + 4
s al f4ytx $If " $ & : < > H J L N b d f p r t v Ă Ƃ ڂ {i #j*B h$ hVh CJ U^J #jA h$ hVh CJ U^J #jJA h$ hVh CJ U^J #j@ h$ hVh CJ U^J h$ hVh ^J h$ hVh CJ ^J 0j h$ hVh CJ OJ QJ U^J mH nH u j h$ hVh CJ U^J #j ? h$ hVh CJ U^J $$ L t Ă $If ڂ ܂ ނ r t ƃ ȃ ʃ Ѓ ҃ ԃ ڃ ܃ r t r`ތ #jrE h$ hVh CJ U^J #jD h$ hVh CJ U^J h" CJ ^J h$ hVh CJ ^J h0]q CJ ^J h$ hVh ^J #jC h$ hVh CJ U^J h$ hVh CJ ^J 0j h$ hVh CJ OJ QJ U^J mH nH u j h$ hVh CJ U^J #jB h$ hVh CJ U^J % ԃ 9 0 * * $If $If gd" kdC $$If s 4 ֈ /J &+ T z 0 + 4
s al f4ytx ԃ ڃ r F kdE $$If s 4 P r !6#e%_'+ ! / / 9 0 + 4
s al f4ytx $If r t
+ f kdG $$If s 4 _ + + 0 + 4
s al f4ytx $If f kd4G $$If s 4 + + 0 + 4
s al f4ytx
& ( * 4 6 : < x ڇ ܇ އ
p r x z ݧ|q_|F| 0j h$ hx CJ OJ QJ U^J mH nH u #jK h$ hx CJ U^J h$ hx CJ ^J j h$ hx CJ U^J h$ hx ^J h$ hx CJ ^J h CJ ^J 0j h$ hVh CJ OJ QJ U^J mH nH u #jH h$ hVh CJ U^J h$ hVh CJ ^J j h$ hVh CJ U^J h$ hVh CJ ^J h$ hVh ^J 8 : < = kdI $$If s 4 Nr +*+ o m 0 + 4
s al f4ytx $$If a$ $If < · ؇ ڇ ܇ އ Z kdJ $$If s 4 F +*+` o m 0 + 4
s al f4ytE $If $$If a$ $If gd
b d n p r l c l c l $$If a$ $If kdGL $$If s 4 qF +*+ o m 0 + 4
s al f4ytE p r t v x L F F F = F $$If a$ $If kdtM $$If s 4 r +*+ o m 0 + 4
s al f4ytx
, . 0 h zr`XF #jvS h$ hxc CJ U^J h CJ ^J #jS h$ hxc CJ U^J hdH CJ ^J #jR h$ hxc CJ U^J h$ hxc CJ ^J j h$ hxc CJ U^J h$ hxc CJ ^J h$ hVh ^J h$ hVh CJ ^J 0j h$ hVh CJ OJ QJ U^J mH nH u j h$ hVh CJ U^J #j O h$ hVh CJ U^J
L F = F = F $$If a$ $If kdvO $$If s 4 _r +*+ o m 0 + 4
s al f4ytx
Z b L J J J J E J gd kdQ $$If s 4 r +*+ o m 0 + 4
s al f4ytx ` d f
" & ( D F H t v ؋ ڋ }k}}Y}} #jtU hdH hxc CJ U^J #j U hdH hxc CJ U^J j hdH hxc CJ U^J hdH hxc CJ ^J ht E CJ ^J hxc CJ OJ QJ hdH hxc 5^J
hwr 5^J
hdH 5^J h$ hxc CJ ^J #jS h$ hxc CJ U^J j h$ hxc CJ U^J h CJ ^J h$ hxc CJ ^J b
$ & r D c kd^T $$If s 4 + + 0 4
s al ytx $If gdlag $$If a$gddH $a$ B F H d f h ʌ ̌ Ό 6 8 : ӹӯuqg_M#jX hdH hxc CJ U^J ht E CJ ^J hxc CJ OJ QJ hxc j h UmH nH u jV h Uj h Uh hQw hdH hxc 5^J
hdH 5^J hxc CJ OJ QJ #j\V hdH hxc CJ U^J h CJ ^J hdH hxc CJ ^J j hdH hxc CJ U^J #jU hdH hxc CJ U^J ̌ m g $If p kd:W $If K$L$s 5
6`, 0 4
s a e4ytx
$If gd K$ $ $If a$ $$If a$gddH d ȍ 6 gdVh ^ kdW $$If s w4 + + 0 4
s al ytx : f h ʍ ̍ 4 8 : V X Z hFU j hFU U#jY hdH hxc CJ U^J #jzY hdH hxc CJ U^J h CJ ^J #jY hdH hxc CJ U^J j hdH hxc CJ U^J hdH hxc CJ ^J 6 1h/R :p.. / =!@"@#$h% c 0 1h/R :p{jj / =!@"@#$h% P 0 } & m6 1h/R :p{jj / =!@"@#@$h% 9 0 1h/R :p{jj / =!@"@#@$h% c 0 1h/R :p{jj / =!@"@#@$h% P 0 v # w9 0 1h/R :p{jj / =!@"@#$h% 9 0 1h/R :p{jj / =!@"@#$h% c 0 1h/R :p{jj / =!@"@#$h% P 0 } & m9 0 1h/R :p{jj / =!@"@#$h% c 0 1h/R :p{jj / =!@"@#$h% P 0 } & m $$If s !v h5 +#v +:V s 0 + 5 +/ 4 4
s as ytG9 $$If s !v h5 +#v +:V s 4v 0 + 5 +/
4 4
s as f4ytG9 $$If s !v h5 /5#v /#v:V s 0 + 5 /5/ / / /
4 4
s as ytG9 $$If s !v h5 +#v +:V s 4 0 + 5 +/
4 4
s as f4ytG9 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 $$If s !v h5 5
5#v #v
#v:V s .0 + 5 5
5/ 4 4
s as ytG9 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 t D d T e x t 3 $$If s !v h5 5
5#v #v
#v:V s 0 + 5 5
5/ 4 4
s as ytG9 $$If s !v h5 +#v +:V s 0 + 5 +/ 4 4
s as ytG9 v D T e x t 1 3 $$If s !v h5 +#v +:V s 0 + 5 +/ 4 4
s as ytG9 $$If s !v h5 +#v +:V s 0 + 5 +/ 4 4
s as ytG9 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 $$If s !v h5
55
#v
#v#v
:V s d0 + 5
55
/ 4 4
s as ytG9 v D T e x t 1 3 $$If s !v h5 +#v +:V s 0 + 5 +/
/ 4 4
s as ytG9 $$If s !v h5 +#v +:V s x0 + 5 +/
/ 4 4
s as yt_ v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 $$If s !v h5 5#v #v:V s 0 + 5 5/
/ / / 4 4
s as yt_ v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 T$$If s !v h5 55555U#v #v#v#v#vU:V s 0 + 5 5555U/ / / / / / / 4 4
s as yt_ t D e C h e c k 4 t D e C h e c k 4 v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 $$If s !v h5 575#v #v7#v:V s 4 0 + ++5 575/
/ / / / 4 4
s as yt_ v D T e x t 1 3 v D T e x t 1 3 v D T e x t 1 3 g$$If s !v h5 55575#v #v#v#v7#v:V s 40 + ++5 55575/ / / / /
/ / / 4 4
s as yt_ t D e C h e c k 4 t D e C h e c k 1 t D e C h e c k 2 t D e C h e c k 3 v D T e x t 1 3 $$If l !v h5 +#v +:V s i 0 + 5 +/ / 4 4
s al yt#U v D T e x t 1 3 $$If l !v h5 +#v +:V s p0 + 5 +/ / 4 4
s al yt#U $$If l !v h5 +#v +:V s ^0 + 5 +/ / 4 4
s al ytx v D T e x t 1 3 $$If l !v h5 +#v +:V s R0 + 5 +/ /
4 4
s al yt v D T e x t 1 3 v D T e x t 1 3 $$If l !v h5 +#v +:V s 0 + 5 +/ /
/ 4 4
s al yt v D T e x t 1 3 $$If l !v h5 +#v +:V s Q0 + 5 +/ /
/ 4 4
s al yt v D T e x t 1 3 $$If l !v h5 +#v +:V s w0 + 5 +/ / 4 4
s al yt7D j D v D T e x t 3 0 $$If l !v h5 y5&#v y#v&:V s 4 0 + 5 y5&/ / / / / / 4 4
s al f4ytFU t D e C h e c k 4 t D e C h e c k 4 $$If l !v h5 5 55q55#v #v #v#vq#v#v:V s 4g0 + 5 5 55q55/ / / / / / / / / / / / / / 4 4
s al f4ytx v D T e x t 3 3 &$$If l !v h5 5
5#v #v
#v:V s 4 0 + 5 5
5/ / / / / / / 4 4
s al f4ytx $$If l !v h5 +#v +:V s 440 + 5 +/ 4 4
s al f4ytx h$$If l !v h5 55T555z#v #v#vT#v#v#vz:V s 4 0 + 5 55T555z/ / / / / / / 4 4
s al f4ytx v D T e x t 3 4 v D
T e x t 3 5 v D @ T e x t 3 6 v D T e x t 3 7 v D T e x t 3 7 v D T e x t 3 7 h$$If l !v h5 55T555z#v #v#vT#v#v#vz:V s 4~ 0 + 5 55T555z/ / / / / / / 4 4
s al f4ytx j D j D
v D @ T e x t 3 6 v D T e x t 3 7 v D T e x t 3 7 v D T e x t 3 7 h$$If l !v h5 55T555z#v #v#vT#v#v#vz:V s 4Z 0 + 5 55T555z/ / / / / / / 4 4
s al f4ytx j D j D
v D @ T e x t 3 6 v D T e x t 3 7 v D T e x t 3 7 v D T e x t 3 7 h$$If l !v h5 55T555z#v #v#vT#v#v#vz:V s 4 0 + 5 55T555z/ / / / / / / 4 4
s al f4ytx | D U P P E R C A S E | D U P P E R C A S E D$$If l !v h5 !5/5/559#v !#v/#v#v9:V s 4P 0 + 5 !5/559/ / / /
/ / / 4 4
s al f4ytx $$If l !v h5 +#v +:V s 4 0 + 5 +/ /
/ 4 4
s al f4ytx $$If l !v h5 +#v +:V s 4_0 + 5 +/ /
4 4
s al f4ytx j D $$If l !v h5 555o5m#v #v#v#vo#vm:V s 4N0 + 5 555o5m/
/ / / / / / / / / / 4 4
s al f4ytx +$$If l !v h5 5o5m#v #vo#vm:V s 4 0 + + 5 5o5m/ / / / / / / 4 4
s al f4ytE v D T e x t 3 7 +$$If l !v h5 5o5m#v #vo#vm:V s 4q0 + + 5 5o5m/ / / / / / / 4 4
s al f4ytE $$If l !v h5 555o5m#v #v#v#vo#vm:V s 4 0 + 5 555o5m/
/ / / / / / / / / / 4 4
s al f4ytx v D T e x t 3 7 $$If l !v h5 555o5m#v #v#v#vo#vm:V s 4_0 + 5 555o5m/
/ / / / / / / / / / 4 4
s al f4ytx $$If l !v h5 555o5m#v #v#v#vo#vm:V s 40 + 5 555o5m/ / / / / / / /
/ / / 4 4
s al f4ytx t D e C h e c k 4 t D e C h e c k 1 t D e C h e c k 2 t D e C h e c k 3 $$If l !v h5 +#v +:V s 40 5 +/ 4 4
s al ytx t D e C h e c k 4 t D e C h e c k 1 t D e C h e c k 2 t D e C h e c k 3 j D L $If K$L$x !v h5 #v :V s 5
6`, 0 5 / 4 4
s e4ytx $$If l !v h5 +#v +:V s w40 5 +/ 4 4
s al ytx t D e C h e c k 4 t D e C h e c k 1 t D e C h e c k 2 t D e C h e c k 3 ^ 6 6 6 6 6 6 6 6 6 v v v v v v v v v 6 6 6 6 6 6 > 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 h H 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 2 0 @ P ` p 2 ( 0 @ P ` p 0 @ P ` p 0 @ P ` p 0 @ P ` p 0 @ P ` p 0 @ P ` p 8 X V ~ _HmH nH sH tH H ` H N o r m a l CJ OJ QJ _HaJ mH sH tH L @ L H e a d i n g 1 $$@& a$ 5EHOJ QJ \L @ L H e a d i n g 2 $$@&a$ 5CJ OJ QJ \F @ F H e a d i n g 3 $@& 5CJ OJ QJ \J @ J H e a d i n g 4 $$@&a$ >*CJ OJ QJ D A D D e f a u l t P a r a g r a p h F o n t V i@ V
0 T a b l e N o r m a l :V 4 4
l a ( k (
0 N o L i s t : B : B o d y T e x t CJ OJ QJ 4 4
Vh 0 H e a d e r
H$ > > Vh 0 H e a d e r C h a r CJ OJ QJ aJ 4 "4
Vh 0 F o o t e r
H$ > 1> Vh 0 F o o t e r C h a r CJ OJ QJ aJ 6 U A6
0 H y p e r l i n k >*B*ph PK ! [Content_Types].xmlj0Eжr(Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi} ;~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭? PK ! ֧ 6 _rels/.relsj0 }Q%v/C/} (h"O
= C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_ 6LR7`0̞O,En7Lib/Se е PK ! ky theme/theme/themeManager.xml M
@}w7c(Ebˮ CAǠҟ7՛K
Y,
e.|,H ,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+&
8 PK ! P theme/theme/theme1.xmlYOo6w toc'vuر-Mn iP@I}úama[إ4:l ЯGRX^6؊>$ !)O^rC$y@ /yH*)UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSe bORD۫qu gZo~ٺlAplxpT0+[}`j zA V2Fi@qv֬5\|ʜ̭NleXd sjcs7f
W+Ն7` g ȘJj|h(KD-
dXiJ؇(x$( :;˹! I_TS 1?E ??ZBΪmU/ ?~xY'y5g&/ɋ>GMGeD3Vq%'#q$8K )fw 9:ĵ
x}rxwr:\TZaG*y8IjbRc|XŻǿI
u3KGnD 1NIBs
RuK>V.E L+M2#'fi ~V vl{u8z H
* :( W ☕
~JTe\O*tHGHY }KNP*ݾ˦ TѼ9/#A7qZ $*c?qUnwN%Oi4 =3ڗP
1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g-
eW
)6-rC Sj
id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q% p%m&]caS l=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f
Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ .uχYC6OMf3or$5N HT[XF64T,ќM0E)`#5XY`פ ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R 3U~7+#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vp IYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07% < ҍ PK !
ѐ ' theme/theme/_rels/themeManager.xml.relsM
0wooӺ&݈Э5
6?$Q
,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{ P8g/ ]QAsم(#L[ PK- ! [Content_Types].xmlPK- ! ֧ 6 + _rels/.relsPK- ! ky theme/theme/themeManager.xmlPK- ! P theme/theme/theme1.xmlPK- !
ѐ ' theme/theme/_rels/themeManager.xml.relsPK ]
& X v H N
8
u
P
~ V $ * j! z @| V " ڂ : " % & ' ) + . 0 2 5 6 8 ; I K P R T V Z _ b d g ~
B $ p | r F : |! Hz F{ | } n > $ ԃ r < p
b ! # $ ( * , - / 1 3 4 7 9 : < H J L M N O Q S U W X Y [ \ ] ^ ` a c e f
) / ? K Q
Q ] c {
& , 4 @ F M Y _ + 1 > J P X d j q } % + 0 < B G S Y ^ j p " $ 0 6 L X ^ ' 3 9 S _ e o { %
1
7
C
O
U
s
" D T {
#
)
C
O
U
! Q ] c ! , 2 4 @ F H T Z \ h n p | $ & 2 8 : F L N Z ` b n t v < H N 2 B # 3 f r x , N FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFG$G$FFFFFFG$G$G$G$FFFFFFFF4F4G$G$F4F4FtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFFFFtFtG$G$G$G$G$G$G$G$FG$G$G$G$ 8 @ 0 (
B
S ? O L E _ L I N K 1 O L E _ L I N K 2
_ H l k 2 5 6 5 9 6 6 4 0 T e x t 3 T e x t 1 3 T e x t 2 9 T e x t 3 0 T e x t 5 9 T e x t 3 3 T e x t 3 4 T e x t 3 5 T e x t 3 6 T e x t 3 7 T e x t 6 0 T e x t 6 1 C h e c k 4 C h e c k 1 C h e c k 2 C h e c k 3 M & ! 5 I ] 3 O
_
Q 3 G [ o C O @ B C E F H I K O = A @ B C E F H I K O 3 3
& & P Q f y ? O / SdaL\
h h^h`o( . 8 8^8` . L ^`L . ^ ` . ^ ` . xL x^x`L . H H^H` . ^` . L ^`L . ^`o( .
^`h H .
pL^p`Lh H .
@ ^@ `h H .
^`h H .
L^`Lh H .
^`h H .
^`h H .
PL^P`Lh H . Sda 1 0 , .. xc x G9 .g: hB hzC 7D )JD | E t E # J #U d lag Vh {jj Yl 0]q Qw dH " a 8 \
FU '[ P 9 ' P $ _ D) wr {6 *] E @ B @
Pa r+
N h h
h h h h $ @ h h h h h h h h z U n k n o w n G * T i m e s N e w R o m a n 5 S y m b o l 3. * A r i a l A B C a m b r i a M a t h " h Yf7Jff , , @ 20 d 4 4 3Q HX $P Vh 2 ! x x J O I N T A P P L I C A T I O N F O R M
T e r r o n e z v m B 5 O D P S G A Oh +'0 ,
L X d
p | JOINT APPLICATION FORM Terronezvm Normal.dotm B5ODPSGA 14 Microsoft Office Word @ L @ b%
@ N@ i ՜. +,0 h p |
, 4 JOINT APPLICATION FORM Title
! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ ` a b c d e f g h i k l m n o p q r s t u v w x y z { | } ~ R o o t E n t r y F i D a t a
j bZ 1 T a b l e / W o r d D o c u m e n t
S u m m a r y I n f o r m a t i o n ( D o c u m e n t S u m m a r y I n f o r m a t i o n 8 M s o D a t a S t o r e 0Riqi 0 P T E A V I G G I D 5 A = = 2 0Riqi I t e m
P r o p e r t i e s U C o m p O b j
y
F' Microsoft Office Word 97-2003 Document
MSWordDoc Word.Document.8 9q