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00. <br />Z J), <br />,�ee-,az,vqe, 94 <br />CITY O�F CENTERVILLE <br />,-,�'�,APPLJCATION FX)R LOT SPLIT/1,A)T COMBINATION/REZONING/SITE <br />PLAN REVIEW <br />Any additional stq irk c!our red for <br />LOT SPLITYL(Yr COMBINATION: FEE: + aigineering, lepi fecs, publimfion or <br />Obey requirmeats, <br />REZONING: DATE PAID: <br />SITE PLA REVIEW. <br />STREET LOCATION OF'PROPERTY: -7607 ,-Oujt e -11 V- <br />FEE OWNER <br />LEASE HOLDER <br />REASGN FOR REQUEST. <br />CONTRACT PURCHASER <br />OPTION TO PURCHASE <br />offiml <br />By paying the, above stated fee, I understand that no refiinds wilil be issued in fu1l or in part, at any time, <br />even if the outcome is denial, <br />f4- I <br />c of,Appliewit Signature of Property Owner <br />4A <br />Date <br />