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HomeMy WebLinkAboutResolution - 051062E - Director Of Civil Defense Authorized To Accept All Grants For Fallout Shelters - 05_10_1962 RL 6c RESOLUTION � 'O� "-' i WHEREAS, the President of the United States has undertaken for the Nation an accelerated and strengthened civil defense program, including a fallout shel- ter program; and, > WHEREAS, a fallout shelter survey has indicated that certain areas of privately owned premises will afford persons protection from the hazard of fall- out in case of enemy attack; and, WHEREAS, as a part of the civil defense program, provision has been made for the granting of licenses or privileges by occupants of buildings to the Federal Government and to political subdivisions of State Governments, which licenses, without compensation, permit the use of the building occupants' pre- mises as fallout shelters; and, WHEREAS, the said grants of licenses or privileges by occupants of buildings must be accepted and approved by the political subdivision of the State; NOW THEREFORE; BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF LUBBOCK: THAT the Director of Civil Defense for the City of Lubbock is hereby given / full authority to execute, accept, and approve, in behalf of the City of Lubbock all grants by building occupants of licenses or privileges to use their premises as fallout shelters. Approved and passed by unanimous vote of the Commission this 10thday of )Tay 1962. ` J CK F. STRONG Mayor AT T Form proved !`l Cit;') ' y Attorney L .venia Lowe, City Secretary-Treasurer A, FALLOUT SHELTER LICENSE OR PRIVILEGE SEE INSTRUCTIONS ON JUNVERSE sms WHEREAS,The president of the United States has on- B. Further,the right to designate the said building .iertaken for the Nation an accelerated and strengthened civil or structure as a civil defense shelter, and to affix defense program,including a fallout shelter program; and thereto, and maintain thereon, at no expense to the Grantor, such civil defense shelter and other signs WHEREAS, a fallout shelter survey has indicated that as are determined appropriate, so long as there is certain areas of the hereinafter described premises will afford no interference with the usual use of the premises persons protection from the hazard of fallout in the event of for the carrying on of business therein. enemy attack; H. The Federal Government, said State and said polit- NOW,THEREFORE, the undersigned,being the owner of ical subdivision may place and maintain on the prem- the hereinafter described premises,or the person otherwise au- ises such appropriate shelter equipment and stocks thorized to grant such license or privilege,does hereby volun- as may be determined necessary,estimated to re- tarily and without compensation, in consideration of the mutual quire approximately one(1)cubic foot per person of promises expressed herein and in cooperation with the Federal, the shelter capacity, and it is expressly understood State,and local civil defense programs for measures to protect - that the Grantor shall have no responsibility or Us- persons against the threat of fallout radiation from enemy at- bility,for the care,protection, or maintenance of the tack,grant to the Federal Government,the State of shelter stocks, wilful damage or bad faith excepted. The shelter stocks and equipment placed in the li- censed or privileged area are to be cared for and and the political subdivision of maintained by said political subdivision at no ex- and to the general public for use in accordance with civil de pence to the Grantor. fense shelter plans, the following license or privilege; III. The Grantor agrees that, during such reasonable pe- 1. A. Use of the basements,corridors,and other common riods as the premises are open for business,the po- areas of the building or structure situated at litical subdivision and the Federal Government, their authorized officers, agents,or representatives, shall have the right to inspect the premises,includ- and known as ing any equipment and supplies stored thereon, so as well as any other common use parts of the said long as this license or privilege is in effect. building or structure which the Federal Govern- meet and the political subdivision shall determine This license or privilege is granted on the express appropriate,including without limitation the rights condition that it shall be valid and binding upon the heirs, to the public of ingress to and egress from theI assigns,or successors in interest of any nature whatsoever, premises, for the sole purpose of temporarily shel- this license or privilege may be revoked by ninety(90)days' tering persons during and after any and every ac- I written notice to the political subdivision and the Federal tual or impending attack. Government, sent by registered mail. Signed, sealed,and delivered this day of 196_ WITNESSES: SEAL ORANTOR(0) The acceptance and approval of the above license or privilege is authorized by the political subdivision of } Standard Location Code Facility Number - (Official Titte) KNOW ALL MEN BY THESE PRESENTS: The.United.States of America acknowledges the voluntary cooperation of the above-named Grantor in the civil defense program of the Nation;and his Government extends its appreciation for-his uncompensated assistance. The above license or privilege is accepted and approved by the United States of America when completed in accordance with its terms and conditions and filed with its authorized representative. ^� Assistant Secretary of Defense(Civil Defense) INSTRUCTIONS FOR USE OF FALLOUT SHELTER LICENSE OR PRIVILEGE LOCAL GOVERNMENT OFFICIAL be typed,stamped,lettered or in longhand prior to contacting person+-"n- 1. Forms may be signed by local official prior to contacting persons in trol of premises. control of structures for signature. Local government official's signature and title may be imprinted by rubber stamp or by using carbon paper,if so 2• When forms have been executed by owner,retain original,return a' desired. Entries in blanks common to a given locality,such as,name of copy to local field office of Army Corps of Engineers or Navy Bureau of State and political subdivision and standard location code number,facility Yards and Docks conducting the survey in your area;present owner with number,address of building or structure and name of building or structure may one copy. The local field offices are: Alabama US Amy Engineer District,Mobile,PO Box 1169,Mobile,Alabama Alaska US Amy Engineer District,Alaska,PO Box 7002,Anchorage,Alaska Arizona US Army Engineer District,Los Angeles,PO Box 17277 Foy Station,Los Angeles,Calif. Arkansas US Amy Engineer District,'Little Rock,PO Box 867,Little Rock,Arkansas California US Army Engineer District,Sacramento,PO Box 1739,Sacramento,California Director,Southwest Division,Bureau of Yards and Docks,1220 Pacific Highway,San Diego,Calif. District Public Works Officer,12th Naval District,San Bruno,California US Army Engineer Pistrict,Los Angeles,PO Box 17277 Foy Station,Los Angeles,California Colorado Us Army Engineer District,Omaha,215 No.17th Street,Omaha,Nebraska Connecticut Director,Atlantic Division,Bureau of Yards and Docks,90 Church Street,New York,New York Delaware District Public Works Officer,Fourth Naval District,Bldg.1,Naval Base,Philadelphia 12,Pa, Florida US Army Engineer District,Jacksonville,PO Box 4970,Jacksonville 1,Florida Georgia US Amy Engineer District,Savannah,PO Box 889,Savannah,Georgia Hawaii US Army Engineer Division,Pacific Ocean,Bldg.96,Ft.Armstrong,Honolulu 13,Hawaii District Public Works Officer,14th Naval Dist.,US Naval Base,Pearl Harbor,Hawaii US Army Engineer District,Honolulu,Bldg.%,Ft.Armstrong,lonolulu 13,Hawaii Idaho US Army Engineer District,Walla Walla,Bldg.602,City-County Airport,Walla Wall.,Washington Illinois US Army Engineer District,Chicago,536 South Clark Street,Chicago,Illinois US Army Engineer District,Rock Island,Clock Tower Bldg.,Rock Island,Illinois Indiana US Army Engineer District,Louisville,PO Box 59,Louisville 1,Kentucky Iowa US Army Engineer District,Rock Island,Clock Tower Bldg.,Rock Island,Illinois Kansas US Army Engineer District,Kansas City,1800 Federal Bldg.,911 Walnut St.,Kansas City 6,Mo. Kentucky US Army Engineer District,Louisville,PO Box 59,Louisville 1,Kentucky Louisiana US Army Engineer District,New Orleans,PO Box 267 Foot of Prytania St.,New Orleans 9,La. District Public Works Officer,8th Naval District,Bldg.16,Naval Station,New Orleans 40,La. Maine District Public Works Officer,1st Naval District,495 Summer St.,Boston 10,Massachusetts Maryland US Andy Engineer District,Baltimore,PO Box 1715,Baltimore 3,Maryland District Public Works Officer,5th Naval District,Naval Base,Norfolk 11,Virginia Massachusetts US Army Engineer Division,New England,424 Trapelo Road,Waltham 54,Massachusetts Michigan US Army Engineer District,Detroit,PO Box 1027,Detroit 31,Michigan Minnesota US Army Engineer District,St.Paul,1217 USPO,180 E.Kellog Blvd.,St.Paul 1,Minnesota Mississippi US Army Engineer District,Vicksburg,PO Box 60,Vicksburg,Mississippi Missouri US Army Engineer District,St.Louis,420 Locust St.,St.Louis 2,Missouri US Amy Engineer District,Kansas City,1800 Federal Bldg.,911 Walnut St.,Kansas City 6,Mo. Montana US Army Engineer District,Walla Walla,Bldg.602,City-County Airport,Walla Walla,Washington Nebraska US Army Engineer District,Omaha,215 No.17th St.,Omaha,Nebraska Nevada District Public Works Officer,12th Naval District,San Bruno,California New Hampshire US Amy Engineer Division,New England,424 Trapelo Road,Waltham 54,Massachusetts New Jersey US Amy Engineer District,Philadelphia,PO Box 8629,Philadelphia,Pennsylvania New Mexico US Army Engineer District,Albuquerque,PO Box 1538,Albuquerque,New Mexico New York US Army Engineer District,New York,111 East 16th St.,New York 3,New York US Army Engineer District,Buffalo,Foot of Bridge Street,Buffalo 7,New York US Amy Engineer District,Eastern Ocean,346 Broadway,New York 13,New York Director,Atlantic Division,Bureau of Yards and Docks,90 Church Street,New York,New York North Carolina Director,Southeast Division,Bureau of Yards and Docks,US Naval Base,Charleston,S.C. US Amy Engineer District,Wilmington,PO Box 1890,Wilmington,N.C. District Public Works Officer,Sth Naval District,Naval Base,Norfolk 11,Virginia North Dakota US Army Engineer District,Omaha,215 No.17th St.,Omaha,Nebraska Ohio US Army Engineer District,Huntington,PO Box 2127,Huntington 18,West Virginia US Array Engineer District,Buffalo,Foot of Bridge St.,Buffalo 7,New York Oklahoma US Amy Engineer District,Tulsa,PO Box 61,Tulsa,Oklahoma Oregon US Army Engineer District,Portland,628 Pittock Block,10th Ave.&Wash.St.,Portland 5,Oregon Pennsylvania District Public Works Officer;4th Naval District,Bldg.1,Naval Base,Philadelphia 12,Pa. US Amy Engineer District,Pittsburgh,925 New Federal Bldg„Pittsburgh 19,Pennsylvania Rhode Island District Public Works Officer,1st Naval District,49S Summer St.,Boston 10,Mass. South Carolina Director,Southeast Division,Bureau of Yards and Docks,US Naval Base,Charleston,S.C. US Array Engineer District,Charleston,PO Box 905,Charleston,S.C. South Dakota US Amy Engineer District,Omaha,215 No.17th St.,Omaha,Nebraska Tennessee US Amy Engineer District,Nashville,PO Box 1070,Nashville,Tennessee US Army Engineer District,Memphis,PO Box 97,Memphis 1,Tennessee Texas US Amy Engineer District,Ft.Worth,PO Box 1600,Ft.Worth,Texas US Array Engineer District,Albuquerque,PO Box 1538,Albuquerque,New Mexico US Army Engineer District,Galveston,PO Box 1229,606 Sante Fe Bldg.,Galveston,Texas District Public Works Officer,8th Naval District,Bldg.16,Naval Station,New Orleans 40,La, Utah US Army Engineer District,San Francisco,180 New Montgomery St.,San Francisco,Calif. Vermont US Army Engineer Division,New England,424 Trapelo Road,Waltham 54,Massachusetts Virginia District Public Works Officer,Sth Naval District,Naval Base,Norfolk 11,Virginia US Army Engineer District,Norfolk,PO Box 119,Foot of Front St.,Norfolk,Virginia Area Public Works Office,Chesapeake,US Naval Weapons Plant,Washington 25,D.C. Washington Director,Northwest&Alaska Division,Bureau of Yards and Docks,Seattle 99,Washington US Army Engineer District,Seattle,1519 South Alaskan Way,Seattle 4,Washington US Army Engineer District,Walla Walla,Bldg.602,City-County Airport, Walla Walla,Wash. �. West Virginia US Amy Engineer District,Huntington,PO Box 2127,Huntington 18,West Virginia Wisconsin District Public Works Officer,9th Naval District,Bldg.IA,NTC,Great Lakes,Illinois Wyoming US Army Engineer District,Omaha,215 No.17th St.,Omaha,Nebraska .. District of Columbia Area Public Works Office,Chesapeake,US Novel Weapons Plant,Washington 25,D.C. American Samoa Director,Pacific Division,Bureau of Yards and Docks,Pearl Harbor,Hawaii Canal Zone US Amy Engineer District,Jacksonville,PO 4970,Jacksonville,Florida Guam Director,Pacific Division,Bureau of Yards and Docks,Pearl Harbor,Hawaii Officer In Charge of Construction Marianas,Public Works Center,Guam Puerto Rico Area Public Works Office,Caribbean,US Naval Station,Son Juan,Puerto Rico Virgin Islands Area Public Works Office,Caribbean,US Naval Station,San Juan,Puerto Rico OWNER OR OWNER'S AUTHORIZED REPRESENTATIVE may be imprinted by rubber stamp or by using carbon paper,if so desired. 1. If the owner is granting a license or privilege for other than the 3. Retain one copy. specified parts of the building or structure,insert description of area in LOCAL FIELD OFFICES OF THE CORPS OF ENGINEERS AND BUREAU space provided in the form. The grantor must initial all changed insertions. OF YARDS AND DOCKS 2. Owner's or his authorized representative's signature on all copies 1. File returned copy and notify State of receipt- U.S.GOVERNMENT PRINTING OFFICE:r962 0-625a20 FALLOUT SHELTER LICENSE OR PRIVILEGE SEE INSTRUCTIONS ON RNYERSE sfDE WHEREAS, The president of the United States has un- 13. Further,the right to designate the said building .rertaken for the Nation an accelerated and strengthened civil or structure as a civil defense shelter, and to affix defense program,including a fallout shelter program; and thereto, and maintain thereon, at no expense to the Grantor, such civil defense shelter and other signs WHEREAS, a fallout shelter survey has indicated that as are determined appropriate, so long as there is certain areas of the hereinafter described premises will afford no interference with the usual use of the premises persons protection from the hazard of fallout in the event of for the carrying on of business therein. enemy attack; H. The Federal Government, said State and said polit- NOW, THEREFORE,the undersigned,being the owner of ical subdivision may place and maintain on the prem- the hereinafter described premises,or the person otherwise au- ises such appropriate shelter equipment and stocks thorized to grant such license or privilege, does hereby volun- as may be determined necessary, estimated to re- tartly and without compensation,in consideration of the mutual quire approximately one(I)cubic foot per person of promises expressed herein and in cooperation with the Federal, the shelter capacity; and It is expressly understood State,and local civil defense programs for measures to protect that the Grantor shall have no responsibility or Us- persons against the threat of fallout radiation from enemy at- bility for the care,protection, or maintenance of the tack,grant to the Federal Government,the State of shelter stocks, wilful damage or bad faith excepted. The shelter stocks and equipment placed in the li- censed or privileged area are to be cared for and and the political subdivision of maintained by said political subdivision at no ex- and to the general public for use in accordance with civil de pence to the Grantor. fense shelter plans, the following license or privilege; III• The Grantor agrees that, during such reasonable pe- t. A. Use of the basements,corridors,and other common riods as the premises are open for business, the po- areas of the building or structure situated at litical subdivision and the Federal Government, their authorized officers, agents,or representatives, shall have the right to inspect the premises,includ- and known as ing any equipment and supplies stored thereon, so as well as any other common use parts of the said long as this license or privilege is In effect. building or structure which the Federal Govern- ment and the political subdivision shall determine This license or privilege is granted on the express appropriate, Including without limitation the rights condition that it shall be valid and binding upon the heirs, to the public of Ingress to and egress from the assigns,or successors in interest of any nature whatsoever, premises, for the,sole purpose of temporarily shel- this license or privilege may be revoked by ninety(90)days' tering persons during and after any and every ac- written notice to the political subdivision and the Federal tual or impending attack. Government, sent by registered mail. Signed, sealed, and delivered this day of 196_ WITNESSES: SEAL GRANTOR(-) The acceptance and approval of the above license or privilege is authorized by the political subdivision of tandard Location Code Facility Number (Offtol-i ria.) KNOW ALL MEN BY THESE PRESENTS: The United States of America acknowledges the voluntary cooperation of the above-named Grantor in the civil defense program of the Nation;and his Government extends its _ appreciation for his rmcompensated assistance. The above license or privilege is accepted and approved by the United States of America when completed in accordance with its terms and conditions and filed with its authorized representative. � ^� Assistant Secretary of Defense(Civil Defense) INSTRUCTIONS FOR USE OF FALLOUT SHELTER LICENSE OR PRIVILEGE LOCAL GOVERNMENT OFFICIAL be typed,stamped,lettered or in longhand prior to contacting person'i--- 6_ 1. Forms may be signed by local official prior to contacting persons in trol of premises, control of structures for signature. Local government official's signature and title may be imprinted by rubber stamp or by using carbon paper,if so 2. When forms have been executed by owner,retain original,return e desired. Entries in blanks common to a given locality,such as,name of ropy to local field office of Army Corps of Engineers or Navy Bureau of State and political subdivision and standard location code number,facility Yards and Docks conducting the survey in your area;present owner with number,address of building or structure and name of building or structure may one copy. The local field offices are; Alabama US Army Engineer District,Mobile,PO Box 1169,Mobile,.Alabama Alaska US Army Engineer District,Alaska,PO Box 7002,Anchorage,Alaska Arizona US Army Engineer District,Los Angeles,PO Box 17277 Foy Station,Los Angeles,Calif. Arkansas US Army Engineer District,'Little Rock,PO Box 867,Little Pock,Arkansas California US Army Engineer District,Sacramento,PO Box 1739,Sacramento,California _ Director,Southwest Division,Bureau of Yards and Docks,1220 Pacific Highway,San Diego,Calif. District Public Works Officer,12th Naval District,San Bruno,California US Army Engineer District,Los Angeles,PO Box 17277 Foy Station,Los Angeles,California Colorado US Army Engineer District,Omaha,215 No.17th Street,Omaha,Nebraska Connecticut Director,Atlantic Division,Bureau of Yards and Docks,90 Church Street,New York,New York Delaware District Public Works Officer,Fourth Naval District,Bldg.1,Naval Base,Philadelphia 12,Pa. Florida US Army Engineer District,Jacksonville,PO Box 4970,Jacksonville 1,Florida Georgia US Army Engineer District,Savannah,PO Box 889,Savannah,Georgia Hawaii US Army Engineer Division,Pacific Ocean,Bldg.96,Ft.Armstrong,Honolulu 13,Hawaii District Public Works Officer,14th Naval Dist.,US Naval Base,Pearl Harbor,Hawaii US Army Engineer District,Honolulu,Bldg.96,Ft.Armstrong,lonolulu 13,Hawaii Idaho US Army Engineer District,Walla Walla,Bldg.602,City-County Airport,Walla Walla,Washington Illinois US Army Engineer District,Chicago,536 South Clark Street,Chicago,Illinois US Army Engineer District,Rock Island,Clock Tower Bldg.,Rock Island,Illinois Indiana US Army Engineer District,Louisville,PO Box 59,Louisville 1,Kentucky Iowa US Amy Engineer District,Rock Island,Clock Tower Bldg.,Rock Island,Illinois Kansas US Army Engineer District,Kansas City,1800 Federal Bldg.,911 Walnut St.,Kansas City 6,Mo, Kentucky US Army Engineer District,Louisville,PO Box 59,Louisville 1,Kentucky Louisiana US Army Engineer District,New Orleans,PO Box 267 Foot of Prytania St.,New Orleans 9,La. District Public Works Officer,Sth Naval District,Bldg.16,Naval Station,New Orleans 40,La. Maine District Public Works Officer,let Naval District,495 Summer St.,Boston 10,Massachusetts Maryland US Army Engineer District,Baltimore,PO Box 1715,Baltimore 3,Maryland District Public Works Officer,5th Naval District,Naval Base,Norfolk 11,Virginia Massachusetts US Army Engineer Division,New England,424 Ttapelo Road,Waltham 54,Massachusetts Michigan US Army Engineer District,Detroit,PO Box 1027,Detroit 31,Michigan Minnesota US Army Engineer District,St.Paul,1217 USPO,180 E.Kellog Blvd.,St.Paul 1,Minnesota Mississippi US Army Engineer District,Vicksburg,PO Box 60,Vicksburg,Mississippi Missouri US Army Engineer District,St.Louis,420 Locust St.,St.Louis 2,Missouri US Amy Engineer District,Kansas City,1800 Federal Bldg.,911 Walnut St.,Kansas City 6,Mo. Montana US Army Engineer District,Walla Walla,Bldg.602,City-County Airport,Walla Walla,Washington Nebraska US Army Engineer District,Omaha,215 No.17th St.,Omaha,Nebraska Nevada District Public Works Officer,12th Naval District,San Bruno,California New Hampshire US Army Engineer Division,New England,424 Tmpelo Road,Waltham 54,Massachusetts New Jersey US Army Engineer District,Philadelphia,PO Box 8629,Philadelphia,Pennsylvania New Mexico US Army Engineer District,Albuquerque,PO Box 1S38,Albuquerque,New Mexico New York US Army Engineer District,New York,Ill East 16th St.,New York 3,New York US Army Engineer District,Buffalo,Foot of Bridge Street,Buffalo 7,New York US Army Engineer District,Eastern Ocean,346 Broadway,New York 13,New York Director,Atlantic Division,Bureau of Yards and Docks,90 Church Street,New York,New York North Carolina Director,Southeast Division,Bureau of Yards and Docks,US Naval Base,Charleston,S.C. US Army Engineer District,Wilmington,PO Box 189D,Wilmington,N.C. District Public Works Officer,Sth Naval District,Naval Base,Norfolk 11,Virginia North Dakota US Army Engineer District,Omaha,215 No.17th St.,Omaha,Nebraska Ohio US Army Engineer District,Huntington,PO Box 2127,Huntington 18,West Virginia US Army Engineer District,Buffalo,Foot of Bridge St.,Buffalo 7,New York Oklahoma US Army Engineer District,Tulsa,PO Box 61,Tulsa,Oklahoma Oregon US Army Engineer District,Portland,628 Pittock Block,10th Ave.&Wash.St.,Portland 5,Oregon Pennsylvania District Public Works Officer;4th Naval District,Bldg,1,Naval Base,Philadelphia 12,Pa. US Army Engineer District,Pittsburgh,925 New Federal Bldg.,Pittsburgh 19,Pennsylvania Rhode Island District Public Works Officer,let Naval District,495 Summer St.,Boston 10,Mass. South Carolina Director,Southeast Division,Bureau of Yards and Docks,US Naval Base,Charleston,S.C. US Army Engineer District,Charleston,PO Box 905,Charleston,S.C. South Dakota US Army Engineer District,Omaha,215 No.17th St.,Omaha,Nebraska Tennessee US Amy Engineer District,Nashville,PO Box 1070,Nashville,Tennessee US Army Engineer District,Memphis,PO Box 97,Memphis 1,Tennessee Texas US Army Engineer District,Ft.Worth,PO Box 1600,Ft.Worth,Texas US Army Engineer District,Albuquerque,PO Box 1S38,Albuquerque,New Mexico US Army Engineer District,Galveston,PO Box 1229,606 Santa Fe Bldg.,Galveston,Texas District Public Works Officer,8th Naval District,Bldg.16,Naval Station,New Orleans 40,La. Utah US Army Engineer District,San Francisco,180 New Montgomery St.,San Francisco,Calif. Vermont US Army Engineer Division,New England,424 Trapelo Road,Waltham 54,Massachusetts Virginia District Public Works Officer,5th Naval District,Navel Base,Norfolk 11,Virginia US Army Engineer District,Norfolk,PO Box 119,Foot of Front St.,Norfolk,Virginia Area Public Works Office,Chesapeake,US Navel Weapons Plant,Washington 25,D.C. Washington Director,Northwest&Alaska Division,Bureau of Yards and Docks,Seattle 99,Washington US Army Engineer District,Seattle,1519 South Alaskan Way,Seattle 4,Washington US Army Engineer District,Walla Walla,Bldg.602,City-County Airport, Walla Walla,Wash. West Virginia US Army Engineer District,Huntington,PO Box 2127,Huntington 18,West Virginia Wisconsin District Public Works Officer,9th Naval District,Bldg.1A,NTC,Great Lakes,Illinois Wyoming US Amy Engineer District,Omaha,215 No.17th St.,Omaha,Nebraska District of Columbia Area Public Works Office,Chesapeake,US Naval Weapons Plant,Washington 25,D.C. American Samoa Director,Pacific Division,Bureau of Yards and Docks,Pearl Harbor,Hawaii Canal Zone US Amy Engineer District,Jacksonville,PO 4970,Jacksonville,Florida Guam Director,Pacific Division,Bureau of Yards and Docks,Pearl Harbor,Hawaii Officer In Charge of Construction Marianas,Public Works Center,Guam Puerto Rico Area Public Works Office,Caribbean,US Naval Station,San Juan,Puerto Rico Virgin Islands Area Public Works Office,Caribbean,US Naval Station,San Juan,Puerto Rico OWNER OR OWNER'S AUTHORIZED REPRESENTATIVE may be imprinted by rubber stamp or by using carbon paper,if so desired. 1. If the owner is granting a license or privilege for other than the 3. Retain one copy. specified parts of the building of structure,insert description of area in LOCAL FIELD OFFICES OF THE CORPS OF ENGINEERS AND BUREAU space provided in the form. The grantor must initial all changed insertions. OF YARDS AND DOCKS 2. Owner's or his authorized representative's signature on all copies 1. File returned copy and notify State of receipt. U.S.GOVERNMENT PR WG OFFICE:1962 0-625020