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el"41 <br />4 L� SGL._ z 4llel?1 <br />VIUAGL OF ORONO No. <br />Crystal Bay, Nunn. <br />Rk4['LST FOR SITE EXMIINATION <br />Complete in Duplicate <br />This form to be used in all applications for permits for building, plumbing, sewage <br />disposal, rezoning, moving a structure, dividing or consolidating parcels of land. <br />Type of Application loiyiding Date ft 25-62 <br />Owner of Property: Name Ona D. Johnson Phone No. Gr 6-3905 <br />Address 4330 _. Crest- Vg1s. Minns <br />Applicant (other than owner) Name tba-rhe at Cn_ Phone No. ar. 2-1133 <br />Address 1012&oasssr2e Blvd. Hound <br />Relationship to Owner Realtor <br />Location (How do we find it?): +n rarnllna Ave_ Casco Point <br />Legal Descriptions pal tt.�r,-a <br />Date Acquired snnn as de -whim Area (sq. ft.) Single Ownsrship? s <br />Separate Ownership <br />Date of last Division of this Property unknown <br />Do you own any Adjoining Property? no <br />Action Requested orti +. tti—vim ni csrnnn �rsit the ting of Raid <br />,`.-i tach sketch, plat plan or survey #n�, an ad i�sal 5d� <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br />RECORD OF ACTION TAKEN <br />Application Received by Date No. <br />Referred to: Date <br />Inspection Conducted by Date <br />Recommendation <br />Planning Commission - Date Considered Recommendationt <br />Planning Commission Subcommittee - Date Inspected Chairman <br />Recommendation <br />Planning Commission - Date Recommendations <br />Council - Date action Taken <br />Permit Issued - Date r Pit., M 1-'V <br />�FlA.y,e <br />