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<br /> <br /> <br />c::rri Gr' ~'T.i...lE <br />2660 CIVlC c:Erlrrn. llirVE <br />~, MIk.~ 55~ <br /> <br />Please cher:..'!.( i~ Q~ ite:s for wt~c;h yoo a.."""'e applyirx;: <br /> <br />t-linc::- Varia.J<.."'::; Pililx.ng or non ~wrize.:i pat1:"..;ay <br />.){ YJ..r:cr Vax.i 1rJC::e; Dei ve\-w'aY <br /> <br />$5e-;-ee' 8/3" If c.'" i./.. ," ,; r~ C <br />$E:-a <br /> <br />Plec.;-;c c:a:;>lete fCD:\ by typi.J;1 or pri.""1tirq in bk. <br />irsufficie.."1t, u..<;e additional sheets, keyil"q irtforration <br /> <br />If the spa~ pnJ'.lided axe <br />to the pl."Cp& it.e!ti n~TS: <br />-"'" --' . r..Jtr.- - ~;< <br />/'Y i ec: il/I:.>...../ "'.,1' ,V..J5 CJ-, <br />-" .... J /' -- t..' <br />\ :.cs~ ~ Ftc..-;e J <br /> <br />1. <br /> <br />..... <br />_____, t:-(IV'c...., <br />Na.-re of ~: FLrst) <br /> <br />J T 5- f/~t'y- <br />{No. arrl Street.\ <br /> <br />C; Ct /).'1 L. <br />r . <br />(~a.oe of Applicant): (First) <br /> <br />(las'c ) <br /> <br />(fho.~,) <br /> <br />L/oil 1.. <br />(1"...icrl1e j <br />/[t5C V,!/~, <br />(City) <br /> <br />1</( <br />(State) <br /> <br />5" j-//3 <br />(Zip) <br /> <br />2. <br /> <br />M-'iress ~f CMiner: <br /> <br />3. <br /> <br />(Midd.l~) <br /> <br />4. <br /> <br />5 4 1'1\ e....... <br />(No.. ard SLree"t) {City.~ <br /> <br />(State) <br /> <br />(Zip) <br /> <br />---- <br />(J..ddress 0::: ,a.ppl.): <br /> <br />5. <br /> <br />.5 q iv\ C-- <br /> <br />street ~--ess 0::: PropErt".:-- Tr:volved: <br /> <br />6. <br /> <br />COi"rp,1 ete Leqal Lescriptior. of I"'r"qx:1-t::.' I..'T....ol',ed: <br /> <br />j] -..? ,- 2:S - ;;- C'C,);- <br /> <br />~-./ <br />7. Present USt of Pruperty: FL <br /> <br />8 . PrP..se.."1t Zc:1i~ of Prvpe..'"1:y: j'i'-;, <br /> <br />9~ Varia..~ 15 req..~C-.~..x--d fra:n tile fallC1W_~rq ::.:.e....-tic:-;(s) of t:,e cit~/ c:x:-=--" <br />! ~ '--; <br />---'-- <br /> <br />iQ, Infonmt.ia., IotUd:1 D1JSt l:e suhDitt.crl fer all awlicatiOP.s: <br /> <br />~.. !\.pI:Jllcat.:.on arri Y"~ <br /> <br />B.. 8-1.2 x l:H site Fl~"'1 srH:,~'i;x; ~r-:-?-"~.:- ~~:':"~:::r d..;,.j l.:a:.."'..:l:::c,;, C: ~;.ll ~:i.sti:1g <br />arC pl"Dp...,...~i iq:':.-v..-e...~-::-l~" <br /> <br />...-:.. \'~ri tt.i.::''"1 aI-'"r:I'cval frl.;:". a-__~rs ex ::.j"i,1i...-:?':;~ 0J~ r:-2...-.t:TY ;:-:::T:Cl;: :cs 3.: :-0\..--tLri. b\" <br />t.~(" varl,J,.T1('e rE\.1"u~~~t... <br /> <br />" <br /> <br />\.;rit.ti..:11 <br /> <br />t.l-'.c <br /> <br />.:~.:-:;-':..J.~:i :.:1-:-:- <br /> <br />.. , <br /> <br />\.;.rFll.:....~~it. <br /> <br />1't-= <br /> <br />:.:i'-~y <br /> <br />st..1 tL:'~~;:.s <br /> <br />\:~":":.'-1.i.;..:~ <br /> <br />~s <br /> <br />;jL""\.........;.:'S~;1..::-~; ~l~ ......i1J.t. ~....""\':.......L:..~l;:....::, ~~...~,:: z:::.c-~~~::.. <br /> <br />