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� <br />0[•7NER <br />JOI3 ADDRCSS <br />LEGAL D�SCRIPTION: LOT <br />P L 0 T P�, A N <br />i� <br />/, <br />vi1�' ` <br />zc�-u�r�C_ �r _ <br />BLOCK OP <br />Applicanl- shall compl��te this form sho;aing all,dimensions of the property <br />structures, and property lines ans disL•ences netween alI exi.sting and pro- <br />posed sL-ructures. I�lso shocv location and dimensions of all streets, <br />rights of ways, alleys, puUlic facilities, easements and tmderground <br />utilities. <br />INDICATE NORTH IN CIRCL� AND SIf0i�7 ALL STREETS AND ALLEYS. <br />PLO'r PLAN TO II� DRAS•N elT AN Ak FROPRI�T� SC11LE <br />I/c•�e cerL-ify Lhat the proposed construction cvil.l conform to the above <br />nlot plan(dimensions and uses) and L-hat no change will be made without <br />fi.r�t obtaining ak7[�rova,l. <br />--A�� '�, � � � `�'f�/ <br />ticant., siy ature Approval � Date <br />