Peter Bane, Keith Johnson & Associates PO Box 5516, Bloomington, In 47407 USA   812-335-0383
Date:		# Acres (+/-)
Name:		Email:
Phone:	Fax	Cell Phone
URL / Website:
Address:
# of people on site, relationship, names, ages:
Occupations:
Lifestyle(s):
Eating Habits:
Level of food self reliance desired:
Handicaps:
Ability to Invest in Site (time on and off land, labor, budget, etc.):
On Site Resources (eg., water, wind, light, carbon, buildings, etc):
Footprint (in total square feet) of existing buildings:
Security of Land Tenure (mineral / water rights, Deed restrictions, zoning, easements, etc.):
Potential Catastrophes (eg., fire, flood, frost, lava, hurricanes, tornadoes, hail, etc.):
List of Plans, maps, drawings available:
History of land (logged, cropped, inhabited, pastured, sprayed, etc.):
Known problems:
Degree of privacy / sociability:
Short and long-range priorities:
Soils:
Water (springs, ponds, surface water, size and volume of watershed, floodlevels, drainage patterns, etc.:
Average Rainfall	Frost Dates: First	Last
Temperature: Minimum		Maximum
Erosion:
Vegetation (flora, forests, exotics, ground covers, poisonous species, rare):
Habitation (fauna - native and introduced, pests, etc.):
Access (existing roads, farm roads, rights of way, etc):
Aspect(s) (N, S, E, W and gradient):
Features (rock outcrops, waterfalls, caves, swimming holes, wind / waterpower sites, views, etc.):
Elevation	Change in elevation: High	Low
Desires and dreams, wants, needs:
Local resources (people, orgs, agencies, sawmill, free plants and seeds, biomass, sand gravel, timber, mulch, etc.):
Available utilities / services (eg., power, phone, sewerage, gas, pv, hydro, shops, schools, public transport, hospitals, fire departments, waste disposal / recycling, etc.):
Additional Comments: