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<br /> <br />rI) <br />~ 1--1D I <br /> <br />CITY OJ' CENTERVILLE <br /> <br />'. <br /> <br />. <br /> <br />APPLICATIoN I'ORM I'OR SAUNA(S) OR MASSAGE .,ARLOR(S) DaNSE <br /> <br />~ -:iL & li-k <br />TllADE NAME <br /> <br />:x~ 01 - .\Lf'\ ()~ <br />UCBNSING PERIOD <br />L,'~ ~~~ ~t~~~t <br />FULL NAME OF APPLICANT <br />OWNER IF INDIVIDUAL <br />11$ Bru.l(\ ~(' <br />ADDRESS <br /> <br />7 -~.) - (o~- <br />DATE OF BIR.11I <br /> <br />J;;Z -I ?J..{)(" <br />DATE OF APPUCATION <br /> <br />~ !Q."S( - (QS"O" f1>Db <br />PHONE NUMBER <br />~51- (g"S3 CGC4Qq <br />Ck~\ll\~ "'~ <br />CITY STATE <br /> <br />~~ <br />PIA! OF BlRnI <br /> <br />ADDRESS OF BU~S <br />LOCATION o.v i () ~\~ Pffi.l\+it- <br />~'\'ts I - ~ ~~ ~\\..e-M~ ~ o~ <br />LIST OWNERS OF Bun.DING OR PREMISE TO BE UCENSED: <br /> <br />NAMES <br />Lo.j~ \)~, \ \if\?s <br /> <br />ADDRESSES <br /> <br />DATE OF BIRTH <br /> <br />MANAGER'S NAME <br />~~ k)/,," <br /> <br />ADDRESS <br /> <br />PHONE <br /> <br />OPERATOll'S NAME <br />~ <br /> <br />ADDRESS <br />I '6, mCA.'~ '& b <br /> <br />PHONE <br /><DSI-(05-()' (qfR1 <br />