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<br />APPLICATION FOR LOT SPLlT/LOT COMBINATION/REZONING
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<br />~~TILOT COMBINATION: ~
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<br />"- REZONlN9f. X
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<br />FEE:tGD +
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<br />Any additional costs incurred for
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<br />other requirements
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<br />DATE PAID:
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<br />STREET LOCATION OF PROPERTY:
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<br />LEGAL DESCRIPTION OF PROPERTY:
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<br />PROPERTY OWNER: ~\.t,S,.... !-!r:J:~,{"'H L,..... PHONE #:
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<br />FEE OWNER: ~(.t~:r;)'!J C-', t.....t1.i':- A^) t; ,~~1kn?'" L!~-:'"
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<br />APPLICANT'S INTEREST IN PROPERTY:
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<br />DESCRIPTION OF REQUEST
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<br />REASON FOR REQUEST: ~
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<br />By paying the above stated fee, I understand that no refunds will be issued in full Or in part, at any time,
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<br />Signature 6f Applicant SigDature of Property Owner
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