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2. <br />3. <br />4. <br />5. <br />f«'®^SS^ca.ionFonn. <br />; SS3.“;'="S-SSi.i;2S.i5.“£?r <br />- ce^Mte of Survey (signed by a licensed surveyor) - refer to handout for survey <br />information. . a«r,lication if not included on required survey. <br />- T^o^^Uc survey (existing and proposed contours) if land alterations involve <br />' ?'^o?th^ SmLfa^clude marital sams) of all persons with an interest in the <br />- n Llty •ms would include name(s) of applicant(s) if not current owner(s). <br />" you wish notified of this application. <br />6. <br />7. <br />8. <br />9. <br />10. <br />--------- <br />YOU ARE TO SOTPLY 30 DOCmffi!^ O^OTY <br />(S-ouire to scale drawings of all documents, plans, etc. to be <br />submitted.) <br />2’“s. ssu— <br />Cenlf,cation by Clerical Department that Und Use Applicarion is complete <br />Initios of Clerical Staff i__________________ <br />APPLICANT’S SIGNATURE formation reauired or requested by the Zoning <br />The applicant hereby agrees no? covered by original fee payment) <br />Administrator, agrees to pay additional fees (sia . certifies that the information <br />1/or unusual expenses^curred ^ ^.ew <br />supplied is true and co^c\ to the \mjif his/hpr krf) = <br />Applicant ’s signature <br />Date^-r <br />OWNER’S SIGNATURE ( „„i,Vnr5on and further authorized reasonable <br />members for purposes of investigation aniPvetlfication oi 4 / _ / <br />Owner’s signature <br />Date <br />of this change prior to the meeting. <br />.