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R'. p,, <br /> StrAffikaf le? <br /> CITY OF CENTERVILLE <br /> CONDITIONAL USE PERMIT REQUEST <br /> NAME: 1/4S S CAM EE Vic' / FEE: $250.00 + $500.00 <br /> Deposit <br /> COMPANY: ` J "PO PAID: 7-50. °O GC ZJ <br /> ADDRESS: t , / R I' iv i3 i / 0 <br /> TELEPHONE NUMBER: ($f--Z , --4 ) _ <br /> STREET LOCATION OF PROPERTY: 7137 204- 41k- #V <br /> PROPERTY IDENTIFICATION NUMBER: <br /> LEGAL DESCRIPTION OF PROPERTY: <br /> SIZE OF PARCEL(S): <br /> CONDITIONAL USE PERMIT REQUEST: / ger a r te— <br /> �P r (-7 G='� 1 r GC -E- CG`JL p et.-c .� r c S -7 CA e'S <br /> I have read the attached City Code, Section 156.030 pertaining to the B-1 Zoning District and the need to apply for a <br /> Conditional - - permit. I have also read the attached City Code, Section 156.320 pertaining to Conditional Uses also. <br /> pay, : the above stated fee, I understand that no refunds will be issued in full or in part, at any item, even if the <br /> o <br /> m H <br /> Signature of Applicant Signature of Property er <br /> Da <br /> (Office Use Only Below This Line) <br /> PLANNING & ZONING ACTION: <br /> CITY COUNCIL ACTION: <br />