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n7 <br /> CITY OF CENTERVILLE <br /> CONDITIONAL USE PERMIT REQUEST <br /> NAME: f fjT, _kl)r"e ��,.- FEE: $250.00+ $500.00 <br /> I k ' Deposit <br /> COMPANY: �1 t",�1 �'Tf„� � L�- PAID: <br /> ADDRESS: <br /> TELEPHONE NUMBER: <br /> STREET LOCATION OF PROPERTY: '7(59 ��c C1.���..✓'Ili <br /> PROPERTY IDENTIFICATION NUMBER: _<;! I , L� ©q <br /> LE�G/�A/L DESCRI1PTIO/N OF PROPERf A, /TY: 7 ke ,!4, �/, /71, 7S -ire f v fit <br /> � �[ <br /> ' !v. <br /> C��f ]'� A Sit. S U�r_ ��6Lt <br /> j <br /> n C <br /> �* a fC/ <br /> 'E <br /> T!1 d �4C etlnr -fO etCtS c�.1/t,ir�-f e <br /> SIZE OF PARCEL(S): I 4 <br /> CONDITIONAL USE PERMIT REQUEST: iv►c c �c n: r f 4 v- <br /> 67. T"iLt�J i�2 4. I� S L� � c h L Ttr'� <br /> /.S adD ZL) G¢ A p- 1� B "rn m apply <br /> I have read the attached Cir Code,Sec on 156. 0 e m to the Z m s t and the need to a 1 for a <br /> Conditional Use permit. I have also re the attached City Code,Section 156.3 0 pertaining to Conditional Uses also. <br /> By paying the above stated fee, I understand that no refunds will be issued in full or to part, at any item, even if the <br /> outcome is denial. <br /> Signature of 14plicant Signature of roperty Owner <br /> fly -1 7-N <br /> Date <br /> -------------------------------------------- <br /> (Office Use Only Below This Line) <br /> PLANNING &ZONING ACTION: <br /> CITY COUNCIL ACTION: <br />