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�aty oi 1Vlounds �1iew, IdII� <br />l�evelo re�e�t A iicaiion , Page 2 <br />Present Use of Property <br />❑ Undeveioped/Vacant ❑ Sing3e Family Dwelting <br />� Duplex/'i'vvo Family Dwetling a Multi-family Dweilin� <br />`�� Business/Cnmmerciai Estabiishment o Indusirial Estabiishment <br />❑ Other (explain) <br />Property Classification � Abstract ❑ Torrens <br />� <br />BY MY (OUR) SIGNATiJRE �1V THIS APPLl'CATION, I HERE$Y DECLARE THAi, TO "I`H� BEST OF MY <br />KNOWLEDGE, THE INF'ORMATIUN PROVIDED IS TRUE AND ACCURATE. . <br />� � � <br />Si�ature of Applicant <br />Name of Appiicant (tyged/printed) C YGf rr G1 %~ - G,`I �7 <br />, <br />Signah�re of Property Qwner Lt9 c�L-� <br />Na�te of Property Owner (typed/printed) ��� <br />, <br />Address of Owner <br />Phone Number of �wnee <br />��*������x*���������*��*�����*�**�**��*�*����**���*��**���������a����*�**�����x�*���*��n�����x��*���� <br />FOIt OFFIC� U�� OI�,Y <br />Date of Submittai �"- /3 _ 9 <br />Date oiAcceptance S° Z,�o - G ' Assigned to: �` �t <br />Ptaiuiiug Case No. .� S-- 60-ciay Limit `7°2,5-�� 120-day Iimi€ _ I L- 25-�� <br />Fees Paid: Aecount # Check # � Receipt # <br />Application: 5°°0 • 8� L D d, 3�'' °) 3 D 3 0� � 03 � <br />Park Dedication: '� <br />Deposits: — ^.. _ <br />Other: <br />Totat: � <br />N:1DAT,�IGROUPSSCOtv(DSVIFQRMS1t?EVAPY.FOR 1/gg <br />