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OOMP <br />114 e <br />CITY OF CENTERVILLE . fle <br />APPLICATION FOR LOT SPLIT/LOT COMBINATION/REZONING/S EA* <br />PLAN REVIEW <br />Arty additional costs incurred for <br />FEE: + engineering, legal fees, publication or <br />other requirements <br />STREET LOCATION OF PROPERTY: <br />LEGAL DESCRIPTION OF PROPERT`Y: Zl—/- 2 �-2 <br />,/` ---- / . . . . . . . . . . . . . . . . . . .............................................................. . I . . ................ . <br />/11 <br />FEEOWNEI <br />ADDRESS: <br />APPLICANT'S INTEREST IN PROPERTY: <br />FEE OWNER CONTRACT PURCHASER <br />LEASE HOLDER OPTION TO PURCHASE <br />DESCRIPTION OF REQUEST: t65'-e'eLl ................ ... . . ........ .... ...... . ... . . ......... . .............................. <br />R�EOjJEST. <br />By paying the above stated fee, I understand that no refunds will be ad in full or in part, at <br />even if the outcome is dcnial. <br />Signature of Applip - I'o i1PSignature of Property Owner( <br />YWA e-0— <br />C:7 — -2 - 16 <br />Date <br />7114 le'9 <br />