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CITY OF CENTERVILLE <br />APPLICATION FOR PRELE IINARY PLAT <br />e Any additional casts incurred for <br />DATE PAID: FEE'�(ZZW + Engineering, legal fees, publication or <br />other reauirements. <br />STREET LOCATION OF PROPERTY: "T .�� ZC� ,k4 e_ <br />LEGAL DESCRIPTION OF PROPERTY: <br />SIZE OF PARCEL (S): te, `Z)GA_-eS <br />NUMBER OF LOTS PROPOSED IN THE PLAT: ASP <br />PROPERTY OWNER: PHONE #:9s�z- <br />FEE OWNER: <br />ADDRESS: <br />APPLICANTS INTEREST IN PROPERTY: ��/U '9 Z Z - xl Uo6 / <br />FEE OWNER CONTRACT PURCHASER <br />LEASE HOLDER OPTION TO PURCHASE <br />REASON FOR REQUEST: <br />By paying the above stated f stan thaX no refunds will be issued in full or in paM at any time, even if the <br />outcome is iW <br />gnature of pplicant Sigri;i& of operty owmn q <br />Date ' <br />