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<br />9. <br /> <br />B. <br /> <br /> <br /> <br />Signature: The above statements are true <br />""~-'=- ";;'~~~'~'~9~ <br /> <br />to the best of my knowledge, <br /> <br />Date: <br /> <br /> <br />Applicant Signature: <br /> <br />Property Owner Signature: <br /> <br />Phone #: <br /> <br />Fax #: <br /> <br />E-mail Address: <br /> <br />Revised December 24, 2003 <br /> <br />Q:\Planning_ Zoning\Application Forms\Conditional Use Permit Application,doc <br /> <br />Page 2 of2 <br />