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~I FOR OFFICE USE ONLY
CASE NO.
DATE SUBMITTED
SITE PLAN APPLICATION
MINIMUM Suit
MIitAL REQUIREMENTS
Slte p}an applic ton cbmp}eted in full
.
$1
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pp
lcatign Pee.
$1.00 OO,T)evelop° ment'rPermit Application Fee
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$3 bI fc i
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Ten ~10) folded ~oples of site`plan
A copy ofthe attach ed`srte plan checklist with all Items checked off or a brief ezplanatlon A$ tp:wh
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hey:
are not checked "off -
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NAME OF P
ADDRESS
LEGAL DESCRIPTION _0, T/ C S, o7 J 6baM !S
leyCl
AJ spiv A L/
APPLICANT (Primary Contact for the Project):
Name
is
Street Address
State _T c Zip Code _7784/5'
Phone Number 1- 44Oq-696 3W 0
PROPERTY OWNER'S INFORMATION:
Name -T1\ riw, A C Q'k d n k- rr~„
Street Address l~tQril I.eet; , r2 City - ; a C`ll k~1 10h
State _T Zip Code -~J7a q g- E-Mail Address.
Phone Number 1,-44 Oq -(pC~6- 664 Fax Number _ 06 - ~76 '1
ARCHITECT OR ENGINEER'S INFORMATION:
Name
•
Street Address
City cC"~ C~'f lq~/
E-Mail Address
City
State Zip Code E-Mail Address
Phone Number ~~5139-a 0q'
6A ~ l OoA Fax Number
OTHER CONTACTS (Please specify type of contact, i.e. project manager, potential buyer, local contact, etc.)
Name n \ n l? V nr> k M C)
Street Address ~ Q (o C1< < a~N e. ~ r 1
State_ Zip Code S'
Phone Number ~p cj S-Q~ S~j
City ( r~ ~S (~V
E-Mail Address
Fax Number b9 (~~')(o
Fax Number 6 to - 71 ,7
oyagWev_SaVMMWA *W RXW.eacll."
APPLICATION DATA
A
CURRENT ZONING
PRESENT USE OF PROPERTY
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•
PROPOSED USE OF PROPERTY Sn ~t lt'J!Q t Ali k eQNd jITi ON ,Nb
VARIANCE(S) REQUESTED AND REASON(S) I\) my
# OF PARKING SPACES REQUIRED I # OF PARKING SPACES PROVIDED
MULTI-FAMILY RESIDENT L ❑ COMMERCIAL
tal Acreage Total Acreage
Fl plain Acreage Building Square Feet
Housin Units 7 Floodplain Acreage
Of ed m Units
# of 2 oom Units
-#o Bedr Units
of 4 Bedroom nits
F 2 BEDROOM UN ONLY
# Bedrooms Z 132 sq.
# Bedrooms < 132 sq. ft.
The applicant has prepared this application and certifies that the facts stated herein and exhibits attached
hereto are true and correct.
•
4
Signature of Owner,
or Applicant
L)-/s--q9
Date
04v* w AocUA9