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t'C(I IIII H J�JIIC.QIWI l. JCiI-1..I1Cl.KIiJI IUI 1.U111�.JICICI ICJS <br /> Nlease note,the applicant must irntial m the boxes below to acknowledge the mirnmum <br /> requirea mtormatbn is mcludec�w�tn tne subm�ttai. tr not,tne ap��ication wiu Nu� tre <br /> acceqtea. C:ail y5L.14y.461u to scheciule a meet�ng wit11 staTt�t you nave quest�ons on <br /> application submittal requirements. <br /> compietea Appiication ��1�IL j <br /> � �,�.:�� �� <br /> Nian Keview ree �aia � l�� � e�� 2 � <br /> ; � � <br /> ,,�� ,��C ���� ���� I <br /> � ►� � ��� C� �1li <br /> �� �1� ��� �� �,, �,�� .�� <br /> n J 5igneo tscrow Hgreement u� tscrow raymeni <br /> �(,�i <br /> rsunaing rians �to scaieJ x� ��� <br /> �� <br /> � ��/ <br /> �erLiricate or 5urvey �to scaie} snowing tne proposea proJect uc C4' <br /> � meeting au requiremenrs xt <br /> � <br /> . � �; <br /> t,__ <br /> �. �" <br /> 'j � haracover c.aicuiations tir appucapie} !�{ G <br /> i"� �` <br /> i <br /> 1 am aware tnat urono wiu not issue a nuuaing permit wiuiout a . �� ��'`-Q <br /> � copy or ricwu permiu �or aocumentation rrom me ricwu statmg � `," � <br /> me proposea proJect aoes not crigger tneir permi�ing � <br /> i requiremenu�. i win contaa tne ric.wu ai y5�-�ii-u5yu <br /> reg Ln a. <br /> 5igned by: <br /> Address: 1-�-�2-c2 , c � /1� ti' ��S � I�...- <br /> Nermit�: �(,'l �7 - fJ�� � 'j � <br /> PacketCasfUpdated� August2015 <br /> Pege 2 <br />