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~i~ ®~ ~~ic~n ~eig~~~ <br />~ian~i~g ~~~li~~~ia~ <br />Action Requested. By: <br />Name of Property Owner <br />~~ ~~ <br />Phone (h} ~ 5 / - ~ ~'lo - ~' ~ ~ ~ (w) <br />Address of Property Owner , ~--~/ ~, ,, ~r? ~ ~. <br />Name of Applicant (if different) . <br />Address Phone <br />Property Involved: <br />Address `~ <br />c~,-~.-~ <br />Legal Description <br />Property Identification Number (PIN) <br />Present Use of Property (check one): <br />o Single Family~Dweliing <br />o Duplex/Two Family Dwelling <br />o Multi Family Complex <br />Action Requested (NON-REFUNDABLE): <br />o Variance ($100.00) <br />o Conditional Use Permit (165.00) <br />o Rezoning ($500.00) <br />o Busi-Hess/Commercial <br />o Government/Institutional <br />o Vacant Land <br />o Lot Split (250.00) <br />o Site Plan Review ($100.00} <br />~ Other (Please Specify) <br />gnated.~esidential, <br />permit .parking area ($].50.00) <br />Brief Summary of bequest (applicant may submit letter to Planning Commission with <br />.details of request): <br />I certiay that all statements on this application are true and correct; <br />~c.~ ~, ~ < <br />5i_gnature t Prog~erty Dwner (required) Signature of,4ppiicant (it aivpficableJ <br />SaFORMSIBLDG PERMIT RPTG FORMSIPLANNING APPLICATION.dac <br />3/5/2003 <br />3~ <br />