Laserfiche WebLink
~ ~ <br />CIT ~' Or LA PORT <br />` APPLIC!1TIOA? FOR _ <br />ZOI•IE CHIlI~1GE RL'QUEST <br />Appli cation P•Io.: - <br />OFFICE USE OI1L1': ree: X100.00 Date Received: ~' - Z~r ~l~l <br />Receipt PIo.: f.~ ~f~~'4r/ <br />( ) Site Plan (~-}- ?Minor Development Site Plan <br />( ) t•ia jor Deve' opn~cnt Site Plan ( ) General Flan <br />( ) Site Plans Submitted on <br />------------------------~------~-~-'---------------------------------- <br />APPLICAIdT' S NAME : / /~ ~ /r9~1C s ~~ <br />Address : `7 f a/ ~~ ~z~ ~ .~-~'- G %~-~ ~-. _ P H : j~ <br />Date : G ~Z~'"~~ Signature <br />O;:iP1ER' S NAP1E <br />Address: ~~ oe ~3 w~ ~ PH: `r'~Z~77 <br />Legal Description of Property w o~~s•S 2 (~-}-See Attached <br />~ Z <br />I Ail ZHE OjdIdER OF THE HEREIN DESCRIBED PROPERTY AND •,~ <br />IS AUTHORIZED TO FILE THIS Arl'LICATION OI1 hl EEHALF. <br />Date: ~ ` a"3- ~' 7 signature: ~ v' <br />Zone ~J Requested Zone Change / SIC No. <br />Proposed Usage . ~6 a-f- s a ~?,v~,~ ~ ~ s ~i ~~7~c.--s' ~1.~-- <br />OFFICE USE ONLY <br />1.) Owner(s) of property within 200 ft. of tract in question: <br /> <br />