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rLom Pr,�` <br /> �- . /_' �T_, _ , �� -�1 <br /> 1�T'PLICF.;�i ��_� � -- <br /> ADDRESS BC� ��v � �� --,�� , <br /> LEGAL Di:�CRIn^IO:d: L0� �� ALOCI: nDllI^I0�4 _�I�,.�-t„�, (/o.'� <br /> U:•]PLTi::.:�: -- <br /> 7`his for.:� sY�ll be cornpleted by Che applicanC ,ho�•ing all dimensiona of tl:;: prop.•rCy. <br /> Shov all 2i-;ens?ons of thc structures (s) and di.mcnsions to property lirics. �Sh�•,; nll <br /> easenents zad other pub�ic facilit.ies located on or wiit�in the �ubject property. <br /> ' II;DICF.TF, ilGR4II 1H CIRCi; ]Q7D SI!0;7 ST::IiS::H ::']D ALLFYS <br /> f <br /> . � <br /> D:.o^ ��:; ^o � � <br /> B:, Dn;:•i:< ^0 � <br /> � � <br /> A`; APPr^..^�ZT�1',,� i � <br /> SCAL�. li <br /> i <br /> , Joc� <br /> ; �� <br /> I � , r <br /> � �� � <br /> . /� <br /> ��;� ',� . <br /> . ��r <br /> I/we cexti.`y that the. propo,ed construcCion �aill confor to the sub;nitted plot plan <br /> _ (dimensioas anQ n�es) and that no chaugc wi11 Ue made without first obtaining approval�. , <br /> NAP16: /i�-^--G� � /� TPPROVI�L . DATE . . <br /> � <br /> _ , � . <br /> a <br />