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<br />1880 MlIl'n Streit · CtnurviIle. M!JV.. SSOJ8
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<br />CHlf 0' CENTERVILLE
<br />LOT S~LlT APPUCAnON
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<br />NAME OF Al'PLICANT Sk"'~,\ c....'ita..lot\~"" c-,..'t nE. 115(J(2.
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<br />ADDRESS r.o, 6.,," c.tts<."Z. ..~:t.f.."l DAYT!M1:11I0mH "SOl- 'l8'~C.loql
<br />DATE ~-L'-O'l- FAXNUM:BER
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<br />LEGAL :o"tSCRll'TION OF PROlfEF.TY
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<br />LEGAL DESClUl'TION OF PRO:POSED LOTS
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<br />PROPERTY ADDRESS; .
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<br />OESCRlPTION OF REQUEST --~rl.-\;. 2.0 AtJ/... i..u. ... ~ I'\(;ro. r"~
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<br />J Signature of property OWIIe
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<br />.. .I'Iu. aDY additiolllll colt incurred for legal fees,
<br />Engineering, publicatioll or other'
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