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APPL I CAT I ON FOR corIo I 11 OrJAL U3E PEf.ll n
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~i L--~,;1i']Y residential
Other j; s{!eCify
project
p&Z Case NUII!ber
Date received
Applicant MM:.c.Al...., IUc..,
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Phone ~G-?741
p,ddress f'o. ~ 4100 etL.\jtd)
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Owner ,:::, {/, r \.t--~'),U
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Address.
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Location of project
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Present use of property
wners of property within 200 feet of all property lines of subject property according
to resent tax rolls: (to be obtained from College Station Tax Office)
Name:
Address:
Attach
sheets if necessary
Fee:
Tax Asses50r or clerk
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Tne appl icont certifies that the above information to be true and correct.
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Signature of applicant, owner, or agent
If application is filed by an agent,a power of attorney statement must be included.