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CERTIFICATIONS <br /> Is this project site included on the "Hazardous Waste and Substance Sites List" or other similar list? <br /> I4 O <br /> Is the proposal an application for a development permit as defined in State law? 0D <br /> (If you're not sure how to answer these questions, please ask staff for assistance) <br /> SIGYATURES <br /> I, THE UNDERSIGNED, DO HEREBY CERTIFY THAT I HAVE READ AND UNDERSTAND THE <br /> ATTACHED COVER SHEET(S) AND THAT THE FACTS AND INFORMATION CONTAINED IN <br /> THE ABOVE APPLICATION ARE TRUE AND CORRECT, TO THE BEST OF MY <br /> KNO EDG . <br /> IvA <br /> SIGN TURE OF PL CANT/AGENT c--- IGNATURE OF OWNER(S) <br /> 6- A-- 9-7 - /o " >'7 <br /> DATE DATE <br /> ALL PROPERTY OWNERS MUST SIGN (IF MORE SPACE IS NEEDED, PLEASE ATTACH A SEPARATE SHEET) <br /> DATE RECEIVED: ZONING DISTRICT: <br /> APPLICATION NUMBER: SP g7-21 RECEIVED BY: - <br /> APPLICATION FEE: �v RECEIPT NUMBER: �O 241 (O 2- <br /> ENVIRONMENTAL <br /> ENVIRONMENTAL REVIEW FEE: 2,3 5 INITIAL STUDY: c� <br /> NOTIFICATION FEE: )`-` A DEVELOPMENT COMMITTEE. ' I ,::-s <br /> TOTAL FEES. CONCURRENT APP. NO.: <br /> I lc<I'7 0 <br /> ADDRESS: ASSESSOR'S PARCEL NO.: ���36 A' <br /> OFFICE USE ONLN <br /> RECEIVED <br /> JUN 13 1997 <br /> c:.applinnc<ipin49,lnn Lin <br /> Ans'd............ <br />