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f : <br />^ • <br />5* <br />required submotals <br />1 Completed Application Fonn. <br />7 Describe request in detail. , <br />, ------Certified Property Owneri Eiii of owprs .wjthin-2|50' (you can obtain this list from <br />■ R^ooepin County Department of Finance, A-603, Government Center. 348-3271), <br />A Pl2lt-------Certificate of Survey (signed by a licensed surveyor) - refer to handout for survey <br />.i' i- :i ': description to application if W:iocl»«led.oii,i<|^ • <br />Xopogn^ suivay.(existing and.ppipcBed e^fWMf$>if land alienoons involve <br />V- ' ■. • iStTtte te^Smef^ude marital satus) of aU persons with an1tiiett|t^the <br />■ - •V': •• nioDeriy Tto would include nainefs) of appliev«sJ.,if.noifu^nt ownerfs). • <br />Q- C^miction pUh. »Wlicab>« VjQ ------As an addendum to this application, please attach a separate list of any other persons <br />‘ you wish notified of thi%-4>plicauoft. . ; <br />'X '\S5KST(S^''”SUBMITTED. (Staff wUl require to scale drawmgs of all documents, plans, etc. to <br />submitted.) <br />The Applicam and Property Owner must sign this application. PIea« romemher that your <br />^plicaLn is not complete if the above information has not been included. <br />Certification by Clerical Department that Land Use AppliiWion is complete. <br />Initials of Clerical Staff:________________________------------------- <br />supplied is true and correct tj/tl^ best of his/ter knowledge. <br />Applicant's signature _ <br />The owner hereby acknowledges and agrees to this <br />entry onto the property by City staff, consultants, agents <br />members for purposes of investigation and verification of this request <br />• I • • <br />• • i* <br />Date a>Pr. /f, <br />I <br />_ Date ja_sffi_raa4tOwner’s signamre _ ^ <br />of change prior co the meeting.