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(Co!Tj)lete in Dupllcfte] <br />This form to he uaetl in all appllcitlons for special us'* j-ormits and for <br />*eiomnp» div dl)\g or con^-oHtUt Inp parcels of lard, vacj stre<»t ;, ail-v, '-. <br />ir»d viria ices. <br />m %■ ATT, •• <br />r <br />/fC y’. A)rllcatlon_Ki'c-/(/a/'/a <nc C <br />f. rJor> <2 4 <br />A: 3o M t) CiiSCo <br />/.f plicnnt (ot^er l.han owner) : fvr .ie____________ <br />A: dress <br />...... !I <br />____ Phon No._ <br />» <br />Ci _________ <br />■phofie T'lo. <br /><• I <br />Ri l itlor.slUp to Owner_ <br />:?nRln3*>r: ^'afne <br />•M m ■ m tmm mu <br />'.and '^lan icr: Nfme <br />:»\ibdiylde r: Naiuc <br />• • •* ■ <br />Phone No. <br />Phone No. <br />Phone No. <br />..ocation fFow do we find Itl) <br />4 .MV % P« <br />},epnl Her. ?r ip tic I /S^ tA^4^^BB6C <br />Date Acquired A ea (sq <br />' b < / o (7?A e' 0 <br />iP > r* ^ • <br />^,’to Of iut )iiv:lsi;>n of this Px^ip^rty <br />»c you OW1 any a< jolnln : ______ _ _________ <br />Action Re |Vesred ^ ^ ^ ^^ >t^ <br />L^Uaw <br />5:i>rataro cf/Applacant <br />^■cr OP <br />Da\ e <br />napec ioi Dej>t./i/f/kk <br />/ indfiiatr it er . <br />' lltage C'»cnc51 r imM <br />^'111 age f igineer / <br />Acticn <br />^x.{ r5/or/». <br />IIIage A torney <br />lanniug Cewaja- m <br />< H If Ifc .< 4*_________________1_»________