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a <br />'i. <br />OT�2NER___� �; `� G V <br />JOII ADDRBSS <br />I,EGAL DESCRIPTIC�I: LOT <br />P L 0 T P L A N <br />BLUCh OF <br />0 <br />oi <br />Applicant shall complete this form showing all dimensions of the prbperty <br />structures, and pioperty lines ans distances between all existing and pro- <br />pos�d structures. nlso sho�a location and dimeasions of all st-reets, '• <br />rights of ways, alleys, public facilities, easements and underground <br />utilities. ' • • <br />N INDICA:'E NORTH IN CIRCLE AND SI30i•7 ALL STREETS AND ALI,EYS. <br />PLOT PLAN TO IIE DRAWN AT AN APPROPRIATE SCAIE <br />.,n <br />.� <br />�-- 6 �l �°vY'^L <br />�w • <br />�0�9 � <br />I/�oe certify that the proposed construction tvill conform to the above <br />p1oC plan(dimensions and uses) and that �io chango will be made without <br />first obt 'ning ap'proval. <br />i' �. ./ �C� 1 . <br />A;�plicants signature Approval Date <br />0 <br />� <br />