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<br /> <br />Ptervi[{e <br /> <br />'EstaGCishd 1857 <br /> <br />1880 :Main Street ~ Centervi[[e,:Jvf3{ 55038 <br />(651) 429-3232 .. 'fa;c (651) 429-8629 <br /> <br />NAME 5CU'Ul0...- <br /> <br />CITY OF CENTERVILLE <br /> <br />SPECIAL USE PERMIT REQUEST - V. lL D, <br />i?Juc.Jc!fJef' FEE# >)JLJ:~,t> C/L-#>S ;/5.3, <br /> <br />PAID: I/;:/OL <br /> <br />c <br />COMPANY: N/A <br />ADDRESS: '-f 312'/ j)ELT 182 C I Ii? <br />TELEPHONE NUMBER: (,<;1- 4l100S'3D <br />STREET LOCATION OF PROPERTY: b~\ivlt: <br /> <br />PROPERTY IDENTIFICATION NUMBER: <br />LEGAL DESCRlPTIONOF PROPERTY: 5ep cLt1o..d'1f'd, <br /> <br />SIZEOFPARCEL(S): I5t/- (lC'veS <br />SPECIAL USE PERMIT REQUEST: V}-CU1 nf d-., <br /> <br />f! . .! <br />LkYU. T <br /> <br />Df lie !O!!Jyy,-ex:.f. <br /> <br />PLANNING & ZONING ACTION: <br /> <br />CITY COUNCIL ACTION: <br /> <br />I have read the attached Ordinance #4, Division ~ Special Use Permits (pag~' -~ I was also presented with that <br />Section of Ordinance #4 1hat I may/may not be in compliance with and fully understand that if I am denied the <br />ramifications of same. <br /> <br />By paying the above stated fee, I understand that 00 refunds will be issued in full or in part, at any item. even if the <br />outcome is denial. <br /> <br />YJj!Jl (C fb{jvL./G--~ <br />Signature of Property Owner <br /> <br />. <br /> <br />Signature of Applicant <br />il/PJ!O"L <br />Date <br />