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OWNER <br />JOB ADDRESS <br />LEGAL DESCRIPTION: LOT <br />P L O T P L A N <br />BLOCK OF <br />Applicant shall complete this form showing all dimensions of the property <br />structures, and property lines ans distances between all existing and pro- <br />posed structures. Also show location and dimensions of all streets, <br />rights of ways, alleys, public facilities, easements and underground <br />utilities. <br />INDICATE NORTH IN CIRCLE AND SHOW ALL S2REETS AND ALLEYS. <br />PLOT PLAN TO BE DRAWN AT AN APPROPRIATE SCALE <br />i <br />v <br />a <br />h <br />,6 <br />2 <br />n <br />9 3 xo <br />I/we certify that the proposed construction will conform to the above <br />plot plan(dimensions and uses) and that no change will be made without <br />first obtainin approval. <br />"�� App icantss gnature Approvaw2 — t} <br />