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APPLICATION FOR CONDITIONAL USE PERMIT
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Applicant
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Phone
Address
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Address
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Location of... proj ect
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Present use of property
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O~'Jn ersofproperty within 200f eet of all" prope rty Ii neso f sub] ec tp rope r ty according
to present tax ro l1s: (to be obta ined from Co 11 ege S~>ati on Tax Offi ce)
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Name: Address:
Attach additional sheetsjf necessary
Application Fee:
l,ni.tiaIs of Tax Assessor or ..clerk
The applicant certifi es'that the abov2 informat'ion 'to be true and correct.
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S ignatureof applicant, owner, or agent
If application is filed by.anagent, ~power of attorney statement must be included.