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APPL I CAT I ON FOR COND ITIONALUSEPERt-1IT
Hu Itifamily res.ident ialproject
V Other- specify CO~V(fiDAJAL use feR.t-{,-rPD(L C.HlJea.I~ C#ILJ::>teJ
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p&Z Case Numbert.5?4-7r;~ Date receivedill.!$!d~
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Appl i cantGHUgc"J-t1 ~J (~t.l.E6G STATIO).} Phone
:::::55 401 A$~v6 D~I~~ess A~ove
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Loca t i on of pro] ec t 6tD~b". . jUt..P5f'pe~r'LA.f;;A . t).,to A-CR.G5
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Cl4nuJ 'BUILDING R>~ cilil51iAJ Hf5l31i,x"S
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Owners of proper tywi th in 200 feet ofl aLl. property 1i nes of subject property according
to present tax ro 11s: (to be obt.s i.n.e. dlf rom.C.o.ll e9. eSJ}s t.ion ....Tax. .O.'.ff.Ic. e. )
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I Address:
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Present use of property
Name:
Attach additional sheets if necessary
Appl ication Fee:
Initials of TsxAssessor or clerk
The applicant certifies'that the above Lnformat"ion to be true and correct.
Si'f:!::::1f~~IIct!t::;, or agent
If application is filed by an agent,~power ofattorneysratementmust be included.
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