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APPLICATION
.
FOR REVIEW AND APPROVAL OF PRELIMINARY PLAT
1. Name or identifying title. of Subdivisions l) ~ 0 \ "\l \ S 1 0 '" <' -f LOT ~ 9 B L... OC K '4
sou T l-\ lAJ 00 D S. E..<:'" T \ 0 '" ~ s-
2. Subdivider: (if owner, so state; if agent or other type of relationship, state details
on separate sheet)
Name I~ (2..,6 A f{2-0 9 l2.-es;; L_d R ?
Address "2... loa S Q () T 1-1 WOO D
Te~ephone t:., ~ 3 - g II 2.-
3. Licensed surveyor or engineer:
Name
Address
Telephone
D f\ \.l \ ,p tv) A " I.~
'2 JO~ SOtllM woOD
tDC!J3- .=-;~?~
4.
Location of proposed Subdivision:
~o ~, T 1-\ (,0 f1 t') ~ s'~c: '\ \ 0 ~~~~ 2- ~-_
5.
Easements or other restrictions on property (describe :generally): -, ~ F F
pOL.. <S .,.
6.
Names of abutting owners and owners directly across adjoining streets (include--
those in other cities):..A D a E M C c.., \<"'0 1a- Yay 0 H \V H 1 B" ~ ~~. ~
7.
Requested variances. The Planning Commission is requested to authorize the
following exceptions to its regulations governing subdivisions with the reason (attach
list of such exceptions with the reason for each set forth): ~ f.) ~j~ t::> L f\- -.
S,21~
8.
The undersigned hereby requests approval by the Planning Commission of the above
identified SubdiViS~~ ~
Signature ~
Title PFLE,S I D~ ~ ..
Date S ~ e e.c ~ ~ ('1 7 (;,
yo- --
- - .. -- .. - .. - - - .. - - ... .. ... -.. - ... - - - ... - - -.. - - .. - - - - - - - - -. - - - .. - - - .. - - - .. - ... -.- - -.. -
This \viII acknowledge receipt of dollars ($ )--.-
in payment of the fee for the above requested approval of applicant's preliminary plat.
Date
Signed
Title
1~s.IS-1,2-70
(Carbon to be retained by app~icant)