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P L C: P L I� N <br />Oi4NER <br />JOII ADDRrSS <br />LL•'G�1L DPSCRIPTION: LO`P 13LOCIC OP <br />npplicant �h;ill complete this Lor.m sho�ving a.'__ dimensions or the nroperty <br />sL-r.ucLures, and pr.operty lines ans distances bei:ween a11 exisi:ing and nro- <br />posed structures. Also ,liow location and dimensi.ons of al]. sL-r.eets, <br />ric�hts of taays, alleys, public !'aci.li.Cies, easements and underground <br />uL-ilities. <br />IIvDICA'..'L'' i�:OR'PII IN CIIiCLB AND SIIOPI.ALL S'1'REI:'PS r1c17 e�LL';75'S. <br />PLOT PLnt� TO I3E DI27�IVN ilT AN iIPPROPRIATL' SCALP <br />I/�ae cerL-ify that the proposed construcl-i.on c•;ill conform to tA� rii�ove <br />plot plan(dimciisi.ons and uses) and that no chan�e �vill be made mithouL- <br />first obtaininy approval. <br />n?plicants signature npproval Date <br />