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APPLICATION
FOR REVIEl:J AI\JD APPROVAL OF PRELIMIN..~RY PL.li.,T
1. Name or identifying t{tle of Subdivision: ..~ee~-rUjOOD - ~--rlOU ~t-'e
2. Subdivider: (if owner, so state; if agent or other type of relationship, state
details on separate sheet)
Name ~eL::)-ruJajD.I lU~. '2.\(!,\-\~ ~l-n.\} V'12E.~ t::E~T
Address ~4~ ~.l'\:5-~ AVe;. @:>~~
Telephone A4-CP ~~I4-~
( ~ Wt..:)'6'Ge. J
3. Licensed surveyor or engineer:
,
Name ~t2.VA..~ ~V~l~e:.ec2..l~&A 'i- ~2)J6'1:'lLJ~ CDr<.~
Address \~ W~l-"~ 2:>LVD. Ct!:)\....\-e&=tB ~\:'~\lO~
Telephone ~ ~.... 4-'l t~
4. Location of proposed Subdivision: ~-e ~-r
5. Easements or other restrictions on property (describe generally): ~~ ~-r
'6. Names of abutting owners and owners directly across adjoining street (include
those in other cities): ~~ ~~;r
,7. Requested variances. The Planning Commission is requested to authorize the foll-
owing exceptions to its regulations governing subdivisions with the reason (attach
list of such exceptions with the reason for each set forth): ~~~
Title
Date
approval by the Planning Commission of the above
8.
The undersigned hereby r
identified subdivision
0~
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This will acknowledge receipt or dollars ($ )
in payment of the fe~ for the above requested approval or applicant's preliminary plat.
Date
Signed
Title
(Carbon to be retained by applicant)