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No*VlU-AGii OF ORONO <br />Crystal Bay, Hinn. <br />RFmi'.ST FOR SITE EXAMINATION <br />(Co!nf)lete in Duplicate) <br />This form to be used in all applications for j>eriiiits for building, plumbing, sewage <br />disposal, rezoning, moving a structure, dividing or consolidating parcels of land. <br />*: <br />■ <br />M- A <br />m -i <br />• * <br />r » . , ^ <br />••• .'J <br />\ <br />t- <br />.// , ~i <br />Type of Application <br />Owner of Property: Name <br />Ad dr__ _ _ _ _ <br />Applicant (other than owner) Name d ^ <br />^^ddre ss _ if ^ <br />Relationship to Owner <br />Date /V/ / <br />Phone No. <br />Phone <br />y?^/y7aA <br />Location ^ow do we find it?): <br />«»#* <br />Legal Description:^/ / id d*y /0 / 77 P , <br />^ ^ ' ^ngle OwneDate Acquired^jVrsa (sq. ft.) <br />Date of last Division of this Property <br />Do you own any Adjoining Prop^ty? <br />Action Requested <br />Ingle Ownership? <br />Separate Ownership? <br />Attach sketch, plat plan or survey and any additional data. <br />j <br />Signature of Applicantpplicant <br />RFCOKl) OF ACTK^ TAKFN <br />Application Received by <br />Referred to: ________ <br />Datei <br />Inspection ConducteU by <br />Recorasendatlon <br />Planning Commission • Date Consideif d J 2^ <br />Date <br />Date <br />Rec CCTsendat ion: <br />? 4 <br />JPlanning Coamission Subcc^itiee - Date Inspected g-/7 Chairmnt::i«><>y. SsMtu •fiLtd <br />Reconsiendat ion X - <br />Planning Comission - Date ^ ~ ^ 4 Rec owwe nda t i on: <br />Cotsicll •• Date lotion Taken <br />Permit Issaed • Date