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APPLICArrIO}r FOR SITE PLA1'1 PEP~'1IT
1 Multifat!lily residential proj ect
Other - s,pecify
p & Z Case Number/p.SjJ Date received
Applicant :t71'A-JJ~P A"7~IA-'T'8S ,UJc..
11i:t~/Jl3
, ,
Address: '~e,~3"-~ ANe
6~Yf\tJ ,"1'1
Telephone:, ~.?14-1
Otmer:
9A-Me
Address:
~
Location of proj ect: Lot (5) t,O-r \ A
of .~~eA7"'MAtz.~ ~t(e.1?I\Jl~DtJ ,~H .?-
Present 'use of property : \J~
Block(s) 6
certtfies".tb.e,abo~.;einf'ormatioi1. tob~ true and correct.
._--~~....~#I; .
,Signature of applicant) O"tvner~ or agent"
IF APPLICATION ISFIltED'BY'AN AGENT:> A PO\.IER OF ATTOHNEY STATE~lE'NT }WST BE IN'eLUDED'..