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<br />:a . :' V t.1V~~ 1880 :llain .,Street ~ (I!nterz'iiL~, :M~li 5_';038
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<br />" ~,'- ~v_ ,CITYOFCENTERVllLE"'--'-':;: -.,.-,~,' ",,"" .., ' __
<br />~~!~~TION F()~ LOT SPLITfOT COMBINAnO~~G::)
<br />~'~'-<"'~"" ._-"~,,---~ ,".""
<br />
<br />LOT SPLIT/LOT COMBINATION:~
<br />REZONING: X
<br />
<br />Any additional costs incurred for
<br />FEE: Uo + engineering, legal fees, publiCation or
<br />other requirements
<br />
<br />DATE PAID:
<br />
<br />STREET LOCATION OF PROPERTY:
<br />
<br />LEGAL DESCRIPTION OF PROPERTY: -;:'e C"f4Jt..rf Su..o.J-<1I. ,ef 'dI.-e~c;t
<br />qtHlltf.eilt., J "5"ec. Z.l ,T 2.J , t2. -.::...., f!:'X<Zyj__1"'a: 77..b f""..-t or -11...,. """""<
<br />G,bo.h-f>i' .H~~~ of A~v 6><",,,,,*' ~ 56 '..,fA )~(;< ..(..~t :;"~e.e d, )'tJ, l~ ~ Cl. ~"''"''-+>.
<br />
<br />SIZE t~{~~CEL(S): 21!:t" Ifclt~ j" '~ 5/1/(, - , '#
<br />
<br />PROPERTY OWNER: GCIl..[)4'" lU. ~..~~l" PHONE #:
<br />
<br />FEE OWNER: ~O -1~," ,~:.. 'fl',,) ""vI> elL 41.,11 4~lf(!:j,
<br />ADDRESS: '!! ~'f $'0
<br />
<br />APPLICANT'S INTEREST IN PROPERTY:
<br />
<br />FEE OWNER
<br />LEASE HOLDER
<br />
<br />j( CONIRACT PURCHASER
<br />OPTION TO PURCHASE
<br />
<br />DESCRIPTION OF REQUEST:~ ReZoNe -the 1'1011..+1..-
<br />~"-OM ReSI'i>/Hvt'141- ~I .f-~ RO(!:<:ID~ArlA.1.. rt..-2.f/
<br />
<br />REASON FOR REQUEST:
<br />
<br />
<br />d that no refunds will be issued in full or in part, at any time,
<br />
<br />,~~~
<br />
<br />Signature of Property Owner
<br />
<br />Date
<br />
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