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oat <br />I <br />For :Jon-l'onfor:niu:; <br />Ca'i I. I;t). <br />VILI,AGE OF <br />Crystal bay, !linnes�,t:+ <br />(Complete in I.Alplicatt) <br />This form to be used in all applications for conditional u::u pr,rmii, <br />and for rezoning, it <br />idinR or consolidating parcels of land, ,;iratinp. <br />streets, alleys and varian--es. <br />Type of Application Date <br />'�brtrtrsrtfctr:rtrry;�-'�'m�ctitttr.at-t►w <br />owner of Property: �laI,-, Phone No. <br />3u>�t t'f arrk '-t+ev ei�'Ptnerat- <br />Phone <br />W. T. Blackraarrq Address <br />�T��T�trt-3txtt-t�nrie- <br />Appl$tQi1#d°8lher than owner : Name Phone No. <br />Peter Coir;ias Address_ �41UiLxY-5.,1�1i -fTarrlerzrtt- <br />General flanag,. Relationship to Owner <br />Engineer: Name-- __r _w._...__.__ ._. ______ _ _Phone ":o .� <br />Land Planncr: Name Phone No. <br />Sub(l iv ider . Name+ _ Phone No <br />Location (How do we f Ind it? <br />Legal Dcscr:ptivn: <br />-ttrt-36; i3i:-i�'1;--P1•ert-{i33Es;-�rcel�-�i�10-1��►-3f3�9 <br />Cite Acquired Area (si. ft.) `,eparate Ownership___ <br />-TV" HA AtcSinple Ownership_____ <br />Date of last divisii_;rl of this l , or.et ty ­-_­__ —-__--___ <br />Do you own any adjoini lig <br />Action Requested_ ;lo,l i _nfor ing_U��*_Parr�itfor�,oIf course. ,- <br />Signature of Applicaat <br />RECORD OF ACTION TAKEN <br />Date Action <br />Inspection Dept: <br />Admini-,trator: <br />Village Council: <br />Village Engineer: _ <br />Village Attorney'e, <br />Planning L0mrn1s:,10:1N RAC �aryor <br />Village Council: <br />Pormif Is>.us:t. Uatr• <br />t.Ult lit 1"ri 1A ,alit .'. '.t l h,' ..;'. <br />_.r �4 �r ._..r-i.►-��._ .r .w- _._.may_/-� _ -. <br />A,lptuAlr.alt,1� <br />