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APPLICATION FOR SITE PLAN PERMIT r;~.\~~.J ~~:7t.! ?\:I'T<C)
P&Z Case No.
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Date Received
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Applicant J::LR I L".A IN. [C"' /\J6'f ('V,
Phone t/- 9,"-3 -8;]:5("1
Address p. C', 7~(?x A l/
Owner D. g, (' AI N.
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Address I3R7/1/(,' j~,
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Architect or Engineer t-lrJRkt F3o.~Ji(
Address -PO, 130'1. A 1/
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S';/1;70IL. ix, Phone
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Location of Project
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Present Use of Property {J/IIDCI./[Ll'PEfJ
property within
to present College
property
rolls:
STATION TAX OFFICE ONLY
Name:
Address:
Attach
\
Tax Assessor or Clerk
fee
THE APPLICANT CERTIFIES THAT THE ABOVE
-
WO~TION IS T,R AND CORRECT
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of applicant, owner or agent
If application is filed by an agent, a power of attorney statement must be included.
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