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C cn teryiffe <br /> � E 445,' <br /> CITY OF CENTERVILLE <br /> APPLICATION FOR LOT SPLIT/LOT COMBINATION/REZONING /SITE <br /> PLAN REVIEW <br /> t)6 Any additional costs incurred for <br /> LOT SPLIT /LOT COMBINATION: f - FEE: Z + engineering, legal fees, publication or <br /> F ' other requirements <br /> REZONING: DATE PAID: <br /> SITE PLAN REVIEW: i l <br /> STREET LOCATION OF PROPERTY: � Z42 Z D Zia L�-1��a I IF '�) zw <br /> LEGAL DESCRIPTION OF PROPERTY: < .5ee <br /> SIZE OF PARCEL(S): <br /> PROPERTY OWNER: L4 Vtre,vr_ P&_+F.esnu PHONE #: S . 29 .0 <br /> FEE OWNER: vJ "\! <br /> ADDRESS: �v <br /> APPLICANT'S INTEREST IN PROPERTY: <br /> X FEE OWNER CONTRACT PURCHASER <br /> LEASE HOLDER OPTION TO PURCHASE <br /> DESCRIPTION OF REQUEST: <br /> i <br /> REASON FOR RF�QUEST: _PA <br /> � s u3 tj r <br /> By paying the above stated fee, I understand that no refunds will be issued in full or in part, .ay.�ny time, <br /> eve if the outcome is d vial. ' <br /> Sig7ture of Applicantgrtttue of Pr6perty caner <br /> Date <br />