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P li O T P L� 1 N• <br />Er/Cc/1-�TT �"�a(=/1/hC S.�ft�i�CIGS FfGd�9�(I � <br />owN�R <br />,l,�,q�p<s�,U � <br />JOA ADDRliSS G-z/`�162C,�.0 • <br />L�GAL D�SCRIPTION: LOT IILOCK UP' <br />L o js 24 fi � 5 l3Ctic2 Ly /��o�s ADa.i �o�cl �Vo• 3 <br />Applicant shall complete tliis form showin9 all dimensions of the property <br />structures, and property lines ans distances between all er.isting and pro- <br />posed structures. Also sho�•: location and dimensions of all streets, ' <br />rights of ways, alleys, public facilities, easements and un3ergroun3 <br />utilitics. ' <br />/ ` INDICA"'1? NORTH IIQ CIRCLE AND SIIOfV ALL STRL�TS AND ALLLY$_ <br />� PLOT PT I:N TO IIE DRA��T1�1 AT AN APPROURIATE SC.�T,F <br />I • • <br />I/�ae certify that the proposed constriction ioill conform to the above <br />pl.ot plan(dimensions and uses) and that no changc wil.l Ue made �•iithcut <br />fi�_�-t uUtaining approval. <br />A;:.k%xicants signature Approval Date <br />