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6 it terviffe <br /> , . <br /> 'Laa6li.Jic,f lR5 <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: b <br /> SITE PLAN REVIEW: <br /> - - -- - - -�T TION OF'�' (�PFRTY• � 0 � ,� l V �. �I� ��- <br /> `� —� -.-_._--------- - - - -- <br /> LEGAL DESCRIPTION OF PROPERTY: <br /> SIZE OF PARCEL(S): <br /> PROPERTY OWNER: PHONE #: <br /> FEE OWNER: t <br /> ADDRESS: <br /> i <br /> APPLICANT'S INTEREST IN PROPERTY: <br /> \FEE OWNER CONTRACT PURCHASER <br /> LEASE HOLDER OPTION TO PURCHASE <br /> DE CRIPTION F REQUEST: <br /> REASO FOR UE C�� �� i <br /> e <br /> y paying the a e state I derst d at no refunds will be issued in full or in part, at any time, <br /> ~� ev he outco � is denial • <br /> Signat e of A li it Signature of Property Owner <br /> Date <br />