|
<br />-
<br />
<br />
<br />, ~
<br />
<br />c=- { C? ?::S~.-':'-=-:L
<br />
<br />2660 C':";ic CE-...""'l7..G:r ::-ri'\~~
<br />P,.cs2vil} e, !-!.L-:r:~--:;~ ::;::;;-: - ;:
<br />
<br />Ple.a-c::.e c::he::::.1.: i~ or l-:.e::s fcr """iric..~ YryJ. a......--e a~'l!'ibq:
<br />
<br />L MLrlor Vari.~t:e; 9illdi..')q or l1Cl1-:-...-....sr.:.::ed
<br />Z.ti...'1:::r Varia."X:e; Dri-,'e.:ay
<br />
<br />'::"i:.:t::'"......--av
<br />- -
<br />
<br />$5'2. (":0
<br />
<br />$~- ,'"'
<br />..;;,:;.......L.;
<br />
<br />Please cx::::-plete fcr.:! by typ:..ryq or printirq in irJ:. If e...., spaces pro-...id9:i are
<br />~-ufficient, use additional sheets.. keyi..""XJ i..lforr.-aticn w t.~o p~;er item ntr:1bers:
<br />
<br />1.
<br />
<br />L~E(PUl ."'vj
<br />1Ja=eo: c...-rx.r:
<br />
<br />(~~,\
<br />
<br />G.x. -.l./S-98
<br />l fl,..or,s I
<br />
<br />( .. ,,'"
<br />~',/f'I.~
<br />(~-L..~'t.j
<br />
<br />.!P,I'I.......;.I'
<br />........ __.;. ~ tV
<br />
<br />(!-u.~e)
<br />
<br />2.
<br />
<br />/0" .0 D
<br />. ~l J I i): l ~- lq..V tJ
<br />Mdress of o...-nar: (:;0,
<br />
<br />H'LL~
<br />a.~ St..--e€t)
<br />
<br />."
<br />,~',-'""5.2 \..'-:i..L.~: .i..1/l/
<br />(Sut.e)
<br />
<br />0"
<br />"\/j
<br />(Ci~.)
<br />
<br />5~/( 3
<br />(Zip)
<br />
<br />~(c-4'S~
<br />(R1:::ne;
<br />
<br />3.
<br />
<br />0;:- t~~.: ()
<br />(I"il-st)
<br />
<br />/- ...
<br />(-.;rc.';;::~i) r r),,~ "!/~'j.
<br />(~1iddle)
<br />
<br />::f:='/..-:S2./"v'
<br />(last )
<br />
<br />Na~ of ~.pplicarrt:
<br />
<br />4.
<br />
<br />S4tYlS-
<br />1..dd....Y'?S,S of _~.f;plicant; (~;o. w-rl SaCE:t:)
<br />
<br />($7'..a t.2 ~
<br />
<br />(Zip)
<br />
<br />(Ci~n
<br />
<br />5.
<br />
<br />f93'-} /;}/.LjL'9,Lt::l H.ILc">
<br />St..'"eet: ;"";,,;rE:S.<;; of Prcpo->..r;:y L'1'.'.:>l'v'e::::
<br />
<br />.',
<br />,,"{i...OAn
<br />
<br />6.
<br />
<br />Cc::plete ~ i~scripticn of Pt'c~y L'1\."olve:i:
<br />('.HRPF";.,' TEl.:? 1'1s:,p, /lc/v'
<br />Lt.); lc .l!x--K F.'\";)fc;:"T~
<br />
<br />- 2. <: - 23 -;3 .. (,'c<;.-q-o
<br />
<br />"D ti.
<br />
<br />E. Prestnt ese of prc;;erty: ..:2.lkJ3..H= ,L-.'Yi"L'7" "'l::.':>- ,)i':" ii'L.
<br />
<br />9. Preser:t ZO:1.il"q af Prcpe..."tj:
<br />
<br />10.
<br />
<br />Var3.~j(';.e is req..~?.s'tci frc::-. i:~e follc;...~ing ~.:..cn (s)
<br />
<br />~'"
<br />~..
<br />
<br />::.\..."e ci::\~ a:e.c:
<br />
<br />11. Infcr:::ati~) ..hi.m I:IJSt 1:c sutv.it'-.ro for aU ~rT;Lic:1tiQ-:S:
<br />
<br />A. ~;::l:..:::at~..c:-l:;.n.::i rue
<br />
<br />B.,
<br />
<br />s\ X 1111 Sit.e ?:~1 sJ-~T't'~:.q r::7~~~-
<br />p:--2'--.......~ i:~rc:';t:..~.e::':.S..
<br />
<br />~ ~,~"7'.c
<br />......-.....---f
<br />
<br />,}. -c.
<br />
<br />:"cc...:;::;::--i c.: all l?-'Xist.i.. ~ a.rxi
<br />
<br />c.
<br />
<br />hT ~ :-+"1:_'""1 3.~':::-:::--..~,1_~ f~~ ~,T:,,2..~
<br />v~::-::'~:'~A:: ~(":r,,-;C:.St.
<br />
<br />',-,,,- :~'~-:::- ?:::;-c::.-:.:.2.;.~ d f f 2-::--2C 'by t.:'..e
<br />
<br />--'
<br />_;J..
<br />
<br />,3.j': :.....__
<br />
<br />0.. 'Tit": ~::::.~ st....ltc'...-:\::.:.'Y'... f:-..::-:-. ~:.~:. '-:;--; ;...~c..'"l;",~ c.:":-;-- :..:~~~_:.;\-; "..-:-.y 't-~2 V..1J:":3.r:C0 is r:cces~')'
<br />~"').:.:. ....~...._1.t :"...J..~"1:;:o:.:~ '-U~ ~~~.c.::~-_;:~.
<br />
<br />
<br />
|