Land Disturbance Application - City of Avondale Estates

< Land Disturbance Application

Applicant Name:

Applicant is:

Applicant Company:

Application Type:

Disturbed Acreage:

Applicant Address:

Applicant City, State, Zip:

Applicant Phone #:

Applicant Email Address:

Project Name:

Site Address, City, State, Zip:

Square Feet of Parcel:

Duration of Activity:

Origin of Fill:

Volume Moved:

Material Removed To:

If contractor was not listed above please fill in your contractor information below.

Contractor Name:

Contractor Phone:

Contractor Fax:

Contractor Email:

Type Full Name:

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