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P .r .1-2-iI G APPLICATION <br /> APPUCANT: L.,/ <br /> Gcrc� <br /> Phone -70( -- '; 7S <br /> ADORES: ( (z 0F.1 ,-(ii l o-C rn,,,,,-„--( 'I <br /> Street Address, City, State, and Zip Code ~, �`;n J S'( i <br /> Interest in Propertey)check appropriate ro nate box): <br /> Owner of Property • <br /> ❑ Contract for Deed Owner <br /> ❑ Lessee, Operator, Manager <br /> ❑ Agreement to Purchase <br /> 0 Other (explain) <br /> Dor-mentary evidence at applicant's interest in the property may be squired before find C: <br /> 'tY=don of his request <br /> PROPERTY INVOLVED• <br /> Ad. <br /> - • -;. - 5-v9, ." <br /> � � I <br /> Legal Description or Property Identification Number o " -2 -z a - 12- o 6 S) - 9- c2/r <br /> Legal Owner: Name/Address -4 f <br /> / -�;.. �� - <br /> . e� . i . -Lt --2_ <br /> y F( 0 -Ccs? C <br /> Present Use (check appropriate box): <br /> ❑ UndevelopedNacant <br /> ❑ Single Family Dwelling <br /> ❑ Duplex/Two Family Dwelling <br /> ❑ Multi-Family (No. of Units <br /> Susiness/Commercia! Establishment <br /> ❑ Industrial Establishment <br /> ❑ Other (explain) <br /> Property Cassification: 0 Abstract <br /> Cr"-Torrens <br /> REQUEST: n <br /> a <br /> / .... i <br /> r U <br /> *Please note: Applicant may be responsible for additional fees <br /> associated with the review of this request <br /> I HEREBY DECLARE THAT THE ABOVE STA T tIMENT ARE TRUE. S� <br /> C2.'`^ �V.rLc, <br /> ""'.*"' ..*....,.. Signature <br /> S200/acre.minimmum *'*_* *+.* <br /> � e P-i to A-2- int ail sonars S20ma 57.000 Pent FundDedication t=ee <br /> Date Paid <br /> ,one Vee P`r it, xi to P.2-S75.ail ea�era� <br /> 2'� <br /> �7eO� $75,ondili +compo Number <br /> Dw«cgJSile Plan Review St CO/acre.minimum 100.maximum S.s00 <br /> Minor Subdivision $150 Toted Pees Paid 'O 7-17-..d <br /> Wear Subdivision 5250 p 5250 deposit Oras Paid �?-T <br /> Cama Plan Amendment $200 Receipt Number <br /> W.ttand Alteration (../- :/ ` <br /> Permit S50 pka deposit d Add <br /> Wetland Buffer Permit S10 Staff Additional r=e.Paid 7 (� <br /> Planning ^ S50 Cate Paid <br /> PUD 5350 Receipt Number <br /> P'J0 Amendment St 50 <br /> Dams at*re: action . <br /> a®. -� . a APPROVED DE.'vic5 [ TAi31 <br /> �Annfta Ca" rjp, / p4''9 <br />