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d�'�. feN" <br />��(�f ���.;C � <br />' poA `;�r�7 <br />�, �" <br />�Ptt ° P�rcme+s��b <br />��� ! 1° `��I �: ; �� �� �: , �; � �. � � ���, � � ;■: _'�. <br />i. <br />��. ::. `� �� ,. ,� � „ �. ��, ,__ <br />�� �� t <br />�• -ti � <br />6i��7�4-3055 <br />61�-784�346Z - FAX <br />I'Iease Type o� print T�for�atior� - Co�Qd� �otb Sdde� of"Ti�i� Fo�n <br />Applica�t 7�ffora��tion <br />Name of Applicant .� > t� <br />! ' Q I TeI�}�oBe i �%"', -- ? � �� <br />Address � � <br />`f ro° � � �° 3}C <br />ni <br />Intes�t ia �ro�perty (ch�c� aPPropriate box) <br />� Owra� of ProperrY <br />� Coa�ct%rDeedOwa�� . <br />� L�.sse�, Operator,lifanager <br />a A�ee�ment to Purchase <br />Q Othcx {e•�pfain) �-- <br />�pp�aeants aaust p�vide e�ide�c� o��ie�eat ir� propeafiv at ihe ti�e oia}r�dicafio�, and if yo�t ae� �ot t�e o�vaer off'tt�� <br />P►°�P��°5'+ Y�� must provid� a le�tter of pe�issioa frotn #he o�n�r �� cousent to i�e �°i1°�� of this �p�licat�o� iixe <br />property o�er ��s$ sig�a t9� applicatioa fo� it to be acc�p�e� <br />: Progerty Des��ip�iu�ro�osaI <br />Address or General Loca�oa -� �� �� r' li _ �� .- <br />Legai Descziption <br />Property Id�n�cadoa � (P1N #� <br />� of rlcres <br />Curreat Zoni,ng <br />�� �� � _ <br />Pres�t Use <br />� Und�vvelopec�/Vacaat <br />y� Singie Farnily Dwe�zag <br />Q Uup(eacl'I'wo Family Dw�fIin� <br />a �1ta.iti-Pamily Dweili�gs <br />a Business/Comaxexcial Establishment <br />� Iadns�°iai EsrabGshinent <br />� Oth� (expiain) <br />�- <br />Type af Aoplic,�tion <br />a Comgreh�nsive Plan Ame�dment $2Q0 <br />a �a� �200/ac; m� $200 �a�c S I000 <br />� Major Subdivisiou �250 ;- �250 de-aosit# <br />Q MinorS�bdivision �I50 <br />a Planned Unit Deveiopment (PC.TD) �;Sp <br />Q PUD Amendment �I50 <br />a Canditional Use Per�ait R-I, R-2 �75; ali ochers �2Q0 <br />�` V�� IZ-1 R-2 �75; alI ottterrs �20Q <br />n Code A�peal �75 <br />a. Develop Revi�w/Site Plaa �100/ac; �,�100 maae �500 <br />�1 WetlaIId.,,itera�on pezmit �50 + d�osit* <br />a Weriand B�er �'�it ? <br />Q Fioodr�iai� Permit �200 <br />� Other <br />*see :vitm�icipa( Cod� for e9cpiatta�on of deposits <br />�x��se co�piet� itae r�ve�� side afi� �pl�c�rio� <br />