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: . <br />nrrLicr::;� <br />ADDRESS <br />LEGhL DiiSCRIPiIO:d: <br />U�]PLA:.��: <br />LO': RLOC�: nDDI ,'S07�I <br />This forr sha11 be compleCed by the apl.licanC ::ha•,ring all dimensionc oL the prc���crty. <br />Shor� al] t'i;:�ensions of the structures (s) and di.m�nsions to property ].irirs. Shrn, ill <br />eacements and other. public faciliCirs located on or wiLhin the eubject property. <br />B� DR.�'r�:: '_'Q <br />A`' 7,?'?,:�Z?A'�'� <br />SCRLE. <br />e <br />ZIiDICATF. I;OR211 1N CIRCL2 AAD SI1D�f STk?EETS i•::D ALLF.YS <br />� <br />� <br />� <br />I/�.e certify thal- the.propoced construcl:ion a�ill confor Co the submitted plot plan <br />(dimensicns and uses) ard that no cbam9c will Uc made withouL• first obtaining approval. <br />/, P o ' � <br />NN1C: ���� C • _ rrnovnr. �(� . i iG''G��' DATG (J < . <br />C�' • -���- <br />� <br />