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Planning Application <br />Present Use of Properly <br />�J Undeveloped/Vacant ❑ Single Family Dwelling <br />' � Duplex%Two Family Dwelling ❑ Multi-family Dwelfing <br />❑ Business/Commercial Establishment CJ Industrial Establishment <br />O Other (explain) • <br />'i. _ <br />Property Classification ❑ Abstrac� <br />Description of Proposal - <br />� Torrens <br />Page 2 <br />BY MY (OUEt) SIGNATURE OiV THIS APPLICATION, I HEREBY DECLARE THAT, TO THE BEST OF MY <br />KNOWLEDGE, THE INFORMATION PROVIDED IS TRUE AND ACCURATE. <br />Signature of Applicant <br />� � � l��i-- <br />Name of Applicant (typed/printed) �R- • �z`�'f� An °°" J� <br />Signature of Properly Owner � ` <br />Name of Property Owner {typed/printed} � �5� <br />Address of Owner -Z�c �� <br />,� �.�/� z <br />Phone Number of �wner ��Za ��'- � 7- <br />********************************************************�***�x*****************�*********** <br />�OR OFFICE USE ONLY <br />Date of Submittal � Y �� � 4 <br />Date of Acceptance Assigned to: <br />Planning Case No. C�� �- o o a 6Q-day Limit 120-day iimit <br />Y12o+ —oo� <br />�`zo�—��3 <br />Fees Paid:� Account # Check # Receipt <br />���: � o o� o0 <br />Park Dedicatlon: <br />Deposits: <br />\/L�' c� �?,Of'r O � <br />Other: �, � � ' a d <br />Total: � � � <br />i � w� <br />. <br />O 43 <br />�v <br />-��• , � <br />� <br />�3S O <br />vsa <br />