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APPLICATION. FOR SITE PLA.t~ PERMIT
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Other..... specify
p &: Z Case Number
Date received
. Applicant: . q~f~. .~~fvv4t~ Cpr~4tOV1
Address: J1tJI? AJr'Vf~r,0(.J1~ ./~ I c::d~~~fbfz(,y, Telephone: '11q-~~~
Ower.: . ~YV\e. . Addres.s: ..~e
Location of Project: Lot(s)3 . f ? Block{s),z,.
of VVOt'D?1'XJL~-h~ k
Present use of property: V~~t-.... ~J. 7Z-~ .
Applicant certifies the above information to
. IF .APPLICATION IS FILED BY AN AGENT) APO,mR OFATTOlrnEY STATEMENT MUST BE INCLUDED.