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Name H 9>lnr.k. <br />OWNER <br />Address . ^ <br />(if different than applicant) Phone (home) <br />Phone (work) 79s~y5*V-^_ <br />Zip; ^ <br />Name Phone (work) <br />Address:City;rr 1 o •4hJ ^ U' • <br />Date Property Acquired <br />(month/year) <br />I (do) (do not) also own the adjacent parcels of land. <br />PRESENT USE OF PROPERTY <br />Present Zoning District LR~lA <br />Present Use of Property <br />Residential <br />Other (specify) <br />DESCRIPTION OF REQUEST <br />Describe request in <br />Estimated Construction Cost $, <br />VARIANCES REQUIRED <br />Lot Area Lot Width <br />Setback Variances (-------- Front <br />Mr- 9^1 <br />___ Hardcover <br />Side _____ Rear) <br />Other / />^f /