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hPP-23-19?3 11:24 <br />pROn IRCMPX <br />OKEEFE ME'IHhNIChL. INC. <br />TO ' 51Z 52« BIS® <br />612 941 1391 P.03 03 <br />l9SO.ev»-23 XO.SSnM l»2S« <br />KHQVmIvD SUBMHTA5.S <br />1 ^ Coinplcict! AppUcaUon Fojm. <br />rnejueit Id cJclOjl. <br />PhiKJicc. A-603, Oovw*nn«ni Ccnlci, 34^32^ handout for iurvcy <br />4. . .>L Ccitificatc uf Survey (siijnr.a by 6 licensed purveyor) <br />?nfonn«Uftn. .r-«i Snriudud OA required eoivcy. <br />Attach Icff.al dcscripUOn 10 application if not in > dwiations involvo <br />To)'OErnpliic lurvey (cxiBllnj. and proposed contourF) <br />‘ ’ chanji^^B in ctcvuilvu (erndca) * ^ ftn Interest in <br />List of lUe ic^al namrs (include m«nle alatoa) Of ^ <br />-------the ptopeny. l-his vsnuld Include nomc(g of <br />ConstwcUon plan, if eppllcoble (sec tXtU for vcparalc list of any oUiOi <br />------AS M *dd«,<lo:.. to this opplicsllon, pl«»to »«"«> » <br />' ’ psraon* you vfieh notified of ihl# application. <br />you ARE lUiQUmKD TO SUPPLY 30 ^ J'ym*'| <br />for RETROUUCTJON ui“ X )7“ Ofl iWl-IAR ..c to Udrawings of all <br />aubmlttod.) <br />Tiu; AvplleBtil and Pfopftiiy Owner nitiat B\%n this appUCflUon. <br />5. <br />0. <br />7. <br />g. <br />9,(f^ <br />fiira <br />! J ’. <br />' -V I*0 C;> <br />CcrtlfiVBth»n by Clerlcel Depattm«Al that I.etid Use complete._________ <br />InUiRlSofCieilMlStBlT:.---------------------------------— —“ <br />Appjicanl'a alghbtuiei^^>^g^a^ ^ <br />^hPWNER ‘S SJONATUKI. ^,.u In iWr Bt>p)ic»i ‘«n fmtlicr culhorlacd <br />OwjtBt'B signatuto ^ ^----- <br />A,«-u„ t.,v. .« ,uw«.t, w. d., f.„ .tr,«. JS '•>? w*" J!?; <br />all tshsiwltd revun roc.-lmf. of Iho ‘‘'"'"'"f ,^7.w»“n "o'hwWd «?«"• •»«''> 7'"'' P'“" “"'**’'tclicaut«d meetpte«>^^e «rRt>aW»iCUW tt> hftV8 8R HU.hWlA <br />Buil!ilr»i & J^onlna 01f'«c of llih clmnge prior in the wcclvn;. <br />r^\}\D SC <br />Tnio) P.M.S <br />TOTAL P.03