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<br /> <br />~ <br /> <br />::rl'i OF K:SI:.VIII.E <br />2660 CIVIC ~ IRlVF: <br />KJSEVlllE, M:I?a\'E5UrA 53113 <br /> <br />Plel2Se dJeck i~ or i~ for ~.idl ycr.J a..>-e awlyi.,~: <br /> <br />_ !4I;ncr Varia."'1Ce; ari.ldi.~ or lor: =--~izej patmiay <br />---.2L ~.inJr vari3.'1CE; Dri Ve!waY <br /> <br />$50.('(: <br />$25 00 <br /> <br />..)/';'1 <br /> <br />..: ~ -~. :..::;--. j.-' <br /> <br />" <br /> <br />c ,_ ..~...~< ,:-' {-=- - <br />'r"~;!~f, ~,,:~ <br /> <br />Please cazple+-..e tom by typin; or prirt'...i.rg in i.."1.~. If the spaces provided are <br />iT1SU.fficient, ~ ?d:liticnal sheets, !<Z"~i.,-x;J infOr.iBt.ion to t:he p..-raper its!!! ~""S: <br /> <br />2. <br /> <br />1. <br /> <br />/:.: ..~-" r'1 ['\..:i <br />~ of ()"oner: <br /> <br />(FL""St ) <br /> <br />/.-1 <br />(Mi.xne) <br /> <br />/ .'1 [; L-C <br />(la=:.-t ) <br /> <br />... '( --; <br />{1 ~ ~ ' <br /> <br />J!/~ j"J :1- L <br /> <br />l-1/t.- <br />(~...a~ ) <br /> <br />C. / /;1 (. . .. <br /> <br />,.., , <br />/'. I :~ = I,. <br /> <br />Ii. ;'L <br /> <br />3. <br /> <br />Address c-f ~: <br /> <br />_5 'r- 1'1 .;.- <br />~Name of ~icant): <br /> <br />(City) <br /> <br />(No. am Street) <br /> <br />(First) <br /> <br />(}".ioo..le) <br /> <br />(last) <br /> <br />4, <br /> <br />5 ~ 1"'! C. <br /> <br />(Ad:iress of ~l.): (No. a."1d S-..reet) <br /> <br />(City) <br /> <br />{State ) <br /> <br />5. <br /> <br />:; OJ ,;; ') :-Z;,P},!~" C' /7(. ~,- <br />street 1d:1ress of ~i Irn;c;lvoo: <br /> <br />c:mpl~te ~~. Descr'~on of PrqJe.rty ~ved: _ <br />.....~... i 6 .'J L" (-'"( -3 ,r"(c) C-{-":-Lt-c" <br /> <br />NJi/.o <br /> <br />6. <br /> <br />7, <br /> <br />Prese."7.: Use of Prq:Jerty: <br /> <br />." ; <br /> <br />8, <br /> <br />Present Zonlrq of ~...ty: <br /> <br />... <br /> <br />9. <br /> <br />Varia.'1Ce is ~...ed fra; the fo:ilewing secti':Jl'\(s} of t..'le city cede: <br />~.-;, -~~:~, 0 <br /> <br />10_ Inf~tion 1Ibich !lUSt b2 SlinittErl for. all awli!:ati~: <br /> <br />A. ~llcat.l.on a..--.:i iec <br /> <br />vs:.{-'-l~i)..1 <br /> <br />(~) <br /> <br />5~ $- !,' '3 <br />{Zip} <br /> <br />(ib::ne) <br /> <br />(Zip) <br /> <br />-- <br /> <br />-:J--- <br /> <br />-- <br /> <br />B. 5-1/2 x U" Site Plan st-.o.;i.'"'J property 1 :"'''1eS, arc locab,o;"! of all existing <br />a,"'rl prq:x:sed L'1pl"C'l.-"a:e!"lts. <br /> <br />C. \"'i~...e.' art:'rov-al 111:1:1 "'-';1ers of aeja..::x;nt ,ir ned...-ty p~ies aff€'C'ted b":' <br />the '"ariaI'la' rsquest, <br /> <br />D. h):itten s""...ateme.!"its f:rr.r.1 t.he a;:plica."\t e."P1,'t,ir,iTD, ..~y the ",~i3.roe is <br />necessal')~ am v.ret harJ.sh.i~ are pl~(t. <br /> <br />