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OWN�R <br />,70B ADDRESS <br />_ P L 0'i' P L l� N <br />� <..��, E /���i�-�c � <br />�DO__.__ ��ai���Ti=� %�:.. <br />LEG1�L DESCRIPTTON: LOT /� z. I3LOCIC S� <br />OF <br />APPlicant shall complete this form showi.ng all dimensions o.� <br />siructures, and property lines ans distances betwecn all eY, the property <br />nosed structures. Also show lor_ai-ion and dimensi.ons of lsti.ng and p1�_ <br />rights of ways, alleys, puulic faci.lities all streets, <br />utilities. � �asements and underground <br />�, <br />� <br />M <br />TNr=C�`"� P70P,TH IN CIRCL� 71Np SIIOT•7 71LL S7'RlirTS 7�Nll IiLL7_iYS. <br />1'LOT PLI�N TO II� DRn��y pT nN pPPP,On12I1aT� SC71L� <br />New <br />� <br />G� <br />0 <br />I/cac cert9.fy th��t the lo � �-- ------.�." _...—_---- <br />ploc p].an(c9imensions and usesa �"���iLuction taill conform to the above <br />Pirst o�taini approval., � a��� that no change taill be made without <br />G � ��'� <br />A��p]:.icants signatur.e � -----_-- / %7� . <br />��pprova]. Uatc <br />c <br />� <br />