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Caty af Moured� `lig�9 � <br />I➢e�elopettettt App���a#io� Pa�e 2 <br />Present Use of Property <br />o UndevelopedNa�ant ❑ Single Family Dweiling <br />o Duplex/Two Family Dwelling , a Ivlulti-family Dweliing <br />❑ Business/Commerciat Esiabiishment o industrial Establishment <br />� OPher {explain) <br />� �B.�M � �u���.. <br />`� <br />-;: , , <br />,;, <br />Property Class�cation <br />Description of I'roposal <br />o Absfract ❑ <br />BY MY (OCJ12) SIGNATURE ON THIS APPLTCA <br />KNOWLLDGE, TI�E INFORMATION PROVIDE] <br />Si�aiure of Applic�nt <br />Name of Appiicant (typed/prinfed) <br />Signature of Properiy Owr�er <br />I�Tame ofProperty Owner (tyge�i/printed) <br />Address of Owner <br />Torrens <br />I HEREHY DECL�'F2�'I�f�AT9 TO T�IE BEST OF MY <br />•.:1' ' : � <br />,: , <br />_ � :,,,..: � <br />;; � � �� _ - _ <br />� . <br />� <br />� ;_, � . <br />� <br />. � � � � •_, ._� . , �� . <br />� �, ,� _ <br />1��� ,� � � � — <br />, � , ; <br />�- <br />� i; �� � N� . ' , t <br />� �' �'.�4 �l `�`�"3 - <br />Phone Numbex of Owner ��� . ��� ` ��� <br />�a�����������x���*����������*�����*����*�*���������#���a�**�*��������������a•x�*�������x*�*��*���**��� <br />FOit ORF'ICE USIE ONLY <br />Date of Submittat � � '�i - �'1 __— — <br />i7ate of Acceptance Assigned to: <br />Planning Case No. '�� �2 �.� �-� o) GO-duy Limit 120-day limit <br />� , 'l,t � 1 ° C3 . O � j l� �,c."7 ) -- ta � � - <br />Fees Faid: AccounE # Check # Receipt # <br />A�plicatzon: � � � �'3 1 F�n �; u („ u � ) '�'°, � l.� I `�_ � � +-f ( P <br />Park Dedic�tion: �__ � v�`� � t �,�� <br />ileposits: _ _ - <br />OFheC: <br />Total: <br />N:IDATA\G120UPS\COMDBVIFORMSIDEVAPP.FOR <br />1l98 <br />