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� <br />OF7NER /I o V fl� � <br />JOB ADDRESS 7J �� . <br />LEGAL D�SCRIPTION: LOT <br />P L O T,P L A N <br />.� ✓Y�r �J'„ <br />BLOCK <br />OP <br />r <br />Applicant shall comp].ete this form showing all dimension� o� the property <br />structures, and property ].ines an� distances between all existing and p.r.o- <br />posed structures. Al.so show location and dinensions of all sireets, <br />rights of ways, alleys, public facil.itie „ ca�ements and underground <br />uti.lities. ' <br />INDICATE NORTII TN CIRCli� A1D SHOT�7 ALL STRliETS AND A?.T_,EYS. <br />}?JOT PLI�N TO B� DRATdN AT AI�: i�PPROPRIAT� SCIILP <br />�` <br />� <br />o- <br />— - t� <br />�� C'O s .. ,� <br />� �-- '; .._.�_ �_._._ ._, i '� ._... _. .�._._...�.,_, <br />I/�oe certify that the proposed construrtion �aill conform b� the above <br />plot p].an(dimensions and uses) and that no change wi11 be made �aithou� <br />fir5'i obtaining appr.oval. <br />� <br />A?plicants signature I�pproval Date <br />. <br />