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<br /> <br /> <br /> <br />o RESIDENTIAL PROPERTY OWNER <br />- $250 <br />fees payable upon submittal of completed application) <br /> <br /> <br />Please complete the application by typing or printing in ink. If the spaces provided are insufficient, use <br />additional sheets, keying information to the proper item numbers: <br /> <br />1. <br /> <br />Nmne Owner: <br /> <br />(First) <br /> <br />(Middle) <br /> <br />(Last) <br /> <br />(Phone) <br />\~ <br /> <br /> <br /> <br /> <br />2. <br /> <br />Address of Owner: <br /> <br />(No. And Street) <br /> <br />(City) <br /> <br />(State) <br /> <br />(Zip) <br /> <br />3. <br /> <br /> <br /> <br /> <br />Narne of Applicant: (First) <br /> <br />(Middle) <br /> <br />( Last) <br /> <br />4. <br /> <br /> <br />113 <br /> <br />5. <br /> <br />Street Addres,y of Property Involved: <br />tlA IH L i f\J~ A V <br /> <br />N <br /> <br />1:)5 i 1"3 <br /> <br /> <br />6. <br /> <br />Conwlete Leeal DescriDtiol1 o(Prooertv Involved & PID No. (below or attachedt. <br /> <br /> <br />except South <br />North, Range <br />(PJD # <br /> <br />7. <br /> <br />032923130077). <br />State exactly wlwt IS unenaea ro oe aone un ur trll: jJl UjJtTI Y l/lW r(:;(jUlreS llle lluenm use <br />penn it: F~'1.l-END '1/H-E C~I2f::""'1 .liE (;'(I~;;;YI Nee Tht\;\\lCRft-f2-y filJ,; <br />'/v\CbL<...Lf-\Q. C'_Uy.;s:KCOt'i'1 T14Hi I I:)b (lfiC"'5Z SC.;.;~T, <br />IHE.. A!')Iv\i N ,'r~A-rI\Jt -r~ .Lt> AL5C Li j::-C Tb <br />Abt:::> Ajo.1t.1.t\~TEjvIPC:.(L/\l2.'t/ tvl()\)L;"lf\~ C:I-A$S~'{'lV\ T\--\A'T IS AFf/<tYllvlffTfL\/ <br />" <br /><2:~J ~OCI B'i7<c ~2.:6\'- ( b ,3ct\.-t SC",\==r ) -rol2- u...'Jt. AS Pr ~L-R5S~t:()(\;\ ST'ftLE <br /> <br />I~ Tl-\C C~ASS A(2~+l S CU,_{ H C,C Tk E f>\2..IAt:: l'Pa.r::: SIQ.\..'-L~W-~€' ANI:> Ellsr <br />to{' THE- 'P1':H-:kli\..Jb LDr, <br /> <br />Page 1 of 2 <br />