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<br />'~,A:PPUCA nON FOR LOT SPLIT(LOT COMBINA nO~~()jIlING>
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<br />LOT SPLITtLOT COMBINATION: ~
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<br />Any additional costs incurred for
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<br />FEE: tGO +
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<br />REZONING: X
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<br />DATE PAID:
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<br />STREET LOCATION OF PROPERTY: Lv: l' \t;rpi:l..F:r-iL 5 Ii ,)0 POi,V
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<br />LEGAL DESCRIPTION OF PROPERTY ~ -r/;e C ,,/4 t' <r J Cu.~~"-~'-< fL c./ f:di fa,!-
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<br />ADDRESS: (,-: tz ':) j (! I! iLr >'" '
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<br />APPLICANT'S INTEREST IN PROPERTY:
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<br />FEE OWNER
<br />LEASE HOLDER
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<br />.J( CONTRACT PURCHASER
<br />OPTION TO PURCHASE
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<br />DESCRIPTIONPFREQUEST: Ib ke-ZC'it<c f11( NOfl,:H~ "17ace.O ,f;".", roulv...,o{ tJ' ,{. '7.7
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<br />REASON FOR REQUEST:
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<br />By paying the above stated fee, I nnderstand that no refunds will be issued in full or in part, at any time,
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<br />Signature of Applicant Signature of Property Owner
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