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PLO'* PIs'�N <br />APPLICANT <br />ADDRESS <br />LEGAL DESCRIPTION: LOT BLOCK <br />U?IPLA::P.D: <br />ADDITION <br />This forn'sh-ill be completed by the applicant showing all dimensions of Lite property. <br />Show ±111 dii.,11sions of the structures(r) and dimensions to property lines. Show all <br />easements and oche. public facilities located on or within the :subject property. <br />0 <br />PLOT PL'::: '_'0 <br />BE DR.,;r:' TO <br />AN APPROPRIATE <br />SCALE. <br />IVD.I1 WE WORTH 11; CIRCLE AND SHOW STRIU S AND ALLEYS <br />ML,IL. <br />3,i 9 -q rl <br />ZO <br />W <br />V 2 / I\ <br />I <br />I/we corLify that the.propused consLrucLion will confor to -the submitted plot plan <br />(dimensions and uses) and that no change will be made without- first obtaining approval. <br />NAME: <br />APPROVAL <br />i'ATE <br />