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OIaNER <br />JOB.ADDR�SS <br />L�G.iL ��SCRIPTION: LO'P <br />P L 0 T P 7, A N <br />IILOCIC <br />� <br />, •, • <br />, <br />,. . <br />�PPlicant shall complete this form showiny all dimensions of the property <br />structures, and property lines ans distances between all existinq a::d pro- <br />posed structures. Also sliow location and dimensions of all streels, <br />rights of ways, alleys, public facilities, easements and underground <br />utilities. <br />II4DICA':� NORTIi IN. CIRCL� A�4D SHOId ALL STREETS AIQD AuLL'Y5. <br />PLOT PLAN TO BE DRA['7N AT AN APPROPRIATE SCALE <br />I/we certify that the proposed consiruci:ion �ai7.1 conform to the above <br />plot plan(dimensions and uses) and tliat no change �aill be made without <br />first obtaining approval. <br />Applicants si.ynature npproval Date <br />, • . <br />R <br />� <br />