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■1-Iw- Y-^'■/ ,-. ■Tfrisimiim.r.-•• •» ■Cl I f or ckm _ riNAia OFFICE <br />0 Ot CiH 200.00 <br />^'"^kEIp}-!HAhT'%cf^ <br />^i;05ii90 cool r<0i riuu <br />12/24m, <br />»d <br />^ n s « s s <br />Zip SS 39 I <br />4 or~ w3To <br />VA.'43.^ntsim tfSB or rrormnrPresent Zoning DistrictPresent Use of Property _ _ _ _ _Reeidentiel__________________________ ________ Other Cspecify) _________oBscumoa or kbqoot ---------------------DSSCUPTIOII or KBQOOTDescribe request in detail, juxjuiX ^q‘a UO* st<Au>y, <br />kbqoikbd soanniuLS <br />1. Completed Application Forsu <br />Property Owners List of owners within 350* (you can obtain <br />J«t.rSV.-Jm)"*""''*" t>‘P.rt«„t of Pi».n«Ve'i°“Gov.rn«i? <br />Stamped, legal sized envelopes (llO) Dre-addr*««aff «•« ^ <br />on the above list with no return addre«. “‘*^"*”*‘* <br />^crtificat€ of survoy. <br />Topographic survey (existing and proposed contoura» if <br />p“t Jl".p “■ “ •PP“«»l. (,„ ,t.f? for <br />Certification by Zoning Department that Land Use Applicltionrc^piite' <br />Zoning Officials Signature ^ ^ <br />APPLICANT'S SIGMATDItB <br />Applicant Date <br />3 K{A.UiL^—lUlA bl <br />OWHBRS SIGNATORB --------------------------- —-->io=wr- ,, j- , <br />.gent., cco^i.slon ™eobL„ .„d lo4T/i7 p^p “«r‘o'^ <br />investigation and verification of this request. <br />^"^^-!-!-!2!!!!!!„_^ ^ate <br />Applicant must have all submittals into the cit-v r>ff{r>«« oc j i. rr <br />pra^M^on-iroY^eTcr^oVr-H ’: <br />unoYH ro*VtY/n/^aY\Y:a\Y:i"LSr4!‘iTeaYe\Y.“e"““- “ <br />:■ ■ : ■• . ...^.. y • • -y";-- <br />••■ UV. • ■ :•*•