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APPLICATION FOR SITE PLAN PERMIT
o Multi -famil y res identi a 1 project
P & Z Case No.
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Other -specify
Applicant:
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Address:
Phone:
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Owner:
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Address:
Locat ion of Project: lot (s)
Block(s)
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Present use of
Applicant cert ifi es.....the..above
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Signature of appLicant, owner or-agent
A POWER OF ATTORNEY STATEMENT MUST BE INCLUDED