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(attach additional sheets if necessary) <br />rBQOIRBD SOBMITT^ _e„^tlon must be e..h~itted hy the application <br />1. <br />2. <br />Completed Application - ownprs within 150' (you must obtain■r.‘rrr.;.=”-’y .4 <br />, „ ...... <br />hardcore?VallleS as required (provide one (1) copy 8H-xll” f- <br />reproduction). ,„a proposed elevations) if any changes <br />hfaf^ddendL*" this “ <br />« • <br />in€or«atio>> has not bean inclad^_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br />APPLICMWS SIGHATORB provide all information required or <br />The applicant hereby ^^rees to provi additional fees (staff <br />requested by the Zoning y^ent) and/or consultant expenses <br />time not covered by ^nd certifies that th« information <br />incurred in review of best of his^^^^^ )tnowledge.supplied is true and correct to the best or <br />Applicant’s Signature <br />Date 2h^ <br />OmBRS SIGHATORB ,orees to this application and furtlier <br />Iuthoriz« \Va?oLble° entry <br />agents, Commission nepbers, and Council m,enbers <br />tion and verification of this request. <br />0%mer's Signature <br />Date <br />Applicant pust have ^.11 XY^VlTTntoJ^Ci^ f/, <br />unable to attend a scheduled meeting, p ^jy^ae the Building * Zoning <br />authorized agent attend in your place and to <br />Office of this change prior to the meeti g. <br />J