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7 A <br /> Y L 0 'i P I� 7� 1� <br /> Oi:;•il•:R <br /> J033 ADDRL•'SS _^ _ <br /> LEGAT D�SCRIPTION: LOT BLOCK OP y. ,_ <br /> A�Plicant shall compleLe this f.orm s}towing all.,dimcnsions oF the property • <br /> st;ruetures, ancl pr.operty lines ans di.stances betwr_en all exi.al_i.ny and pro- <br /> po:;ed structures. A1Go sitow location and dimensions of �11. strc��ts, <br /> ri.ghts of. ����ys, alleys, puUlic Lar_il.itic:s, ca:�ements and und�rgr.oun3 <br /> uti.l.ities. / <br /> �� 1:NDSCA'PP•. 1�IOIZTII Iid CLRCI,1: el?ID Sf10FI 11I,f. STI'il;1i'L'i il'�ID e�.liLCSS. <br /> PLOT PLi�tl TO f3� DP.AC]IJ AT tliQ T,PPI;OPRIATE SCAL�?3 . � ��. <br />' � <br /> � � <br /> J ('� <br /> � <br /> � <br /> � I <br /> _ � /� <br /> e � � <br /> �o, <br /> , , <br /> _ ��.--- -----� -• --------._-- —____.. :, _ -____.._. _.__�.�_..---- <br />� a <br />; I/we cerL•it:y thaL- the proposr_d construction �vi.Ll conf-orm to t:he a,ove <br />, plot ple�n (dimcn�ion� and uses) and that no change soill bc madc withouL- <br />� 1:irst obtaining approval.. <br /> � ` i <br /> fi �, <br /> �C .-.��,..u�� -�1. �' :,,<. f cf, <br /> A��plicantu siyi , l:u�`,� T,pproval Date <br /> V <br /> i <br /> � <br />