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ente rviffe <br />GctQb(Lc{lu� LS.i',' <br />CITY OF CENTERVILLE <br />APPLICATION FOR LOT SPLIT/LOT COMBINATION/REZONING /SITE <br />PLAN REVIEW <br />Any additional costs incurred for <br />LOT SPLIT /LOT COMBINATION: � FEE > + engineering, legal fees, publication or <br />other r quir ents <br />REZONING: DATE PAID: I � V (�� <br />SITE PLAN REVIEW: <br />`v <br />STREr, i LO%A OF FRaFl✓RTI': <br />LEGAL DESCRIPTION OF PROPERTY: <br />SIZE OF PARCEL(S): 'S —e- <br />PROPERTY OWNER: PHONE #: <br />FEE OWNER: <br />k <br />AD DRESS: �U� \�� `r \,U \� <br />AD \ <br />S � � � <br />APPLICANT'S INTEREST IN PROPERTY: <br />FEE OWNER CONTRACT PURCHASER <br />LEASE HOLDER OPTION TO PURCHASE <br />DE CRIPTION F REQUEST: <br />REASO� UE� <br />the ale stated -.few I qnderst d� at no refunds will be issued in full or in part, at any time, <br />outco is denial. <br />Signat e of A li t Signature of Property Owner <br />-- �'A <br />Date <br />/6� <br />