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APPLICATION FOR CONDITIONAL USE PERt11T
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P&Z Case Number Date received
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App 1 i cant71~11 TAd AIIIII1itAft~N;f7
Address .~r Ca4-Siltlt, lJalllf.
Owner 5A~f-
Phone ~"144"
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Address
Location of project
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Present use of prop~r~y
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Owners of property within 200 feet of all property lines of subject property according
to pre5~n t. t. a..x.. r._:...ll.. S : (to be Otb .t..a. i.ne..d.. _..f r.om...... C. o. 1,.1.,. e.ge...s. t....a......t.i. on. ~.. . a.. .~ ..Of.. ~.~.~. e. >. ....\ .'. II ....._(.... '." .... - ..''''' '~..'.
Name: Rmt.N,~(:1f?.J .tJt~~~~dr1:s~. T3~>..J77) ~~B ry-v:)u~rl""7J6l1
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Initials of Tax Assessor or clerk I -;.-; oV'1
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The applicant certifies that the above information
agen.t
If application IS filed by ana-~ent. a pO VoJerof.attorney statement must be included.
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