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APPLICATION CONTROL SHEET <br /> 17 . . <br /> SKRr E-Ttl,Se<°mpldtl b'f bbEpmMl Sarvvs s 1 ., - <br /> "u Dale: <br /> Foe: flacelpl Number. <br /> Pronpp OnM: ❑Yee {yNo ry Dole: r-2G-9 <br /> Fee: C-60 no<olpt Number. ( e gr <br /> FIIo Number: yl.} <_qy- Dot*:: <br /> Foe: nocalpl Number. <br /> FII°Number: Data: <br /> Filo Nmnbor: <br /> Poe: nocalpl Number. <br /> D Ipll f r i t r" IS (nod <br /> P Z, Yx p <br /> z � <br /> 7 oru n <br /> Protect Locmlom � S. <br /> ndarafa: u r 6' A+r f 14 <br /> APNmu — <br /> I Ganoml Plan Dosignnllan: <br /> Genaml Plon Community: QJ�[v i <br /> Z IgM p <br /> plopelty,Zoning: 9(` )valley Zone(s): <br /> Zoning <br /> nd(ocaGen.,.[Denel Plan <br /> RR <br /> Nmth: -� <br /> South: <br /> East: <br /> P ,LK <br /> Wo:u <br /> Supervlsa�lol Dlslil<I: <br /> 100.Yenr 61oed 33 Yes $r+° m <br /> Willieson Act ❑ Yes <br /> ryF(o <� <br /> N pea A SP In PI I I ❑ yes ❑ N . <br /> m.toN 17L-73 (S-I-, SO ay lx, I <br /> CKLIST'''i ... . <br /> An Applications <br /> Completed Application Forma 2-An <br /> Gwnari Signalun p� <br /> Copy of Dead at Pmliminnry Tltlo fiepod <br /> Copies at rtan ar Map D/ <br /> BY.'x I I'neddeod Plnn or Mnp D' <br /> Humdouf Wallets CISCIGfela Survey ❑ <br /> Davolopmonl Impact Mllignllon Foo Fenn ❑ <br /> Aasosso,and Mstory Pages B� <br /> 'Al, w <br /> ' Se7m Walar WServo'Lane, <br /> Memos Ust • ❑ <br /> Genaml Plan Map' <br /> ❑ Zoning Map• ❑ <br /> Sells Itopoa <br /> ❑ Soils Suitability Study• ❑ <br /> Subfldance Aree D Yes <br /> o Expensive Soil Arae Rr,Yes ❑ No <br /> • llmse materials may not be roqulred for cmlain oppllcellay. Chock the application typo ter dotells. <br /> Tentative Mops <br /> Map Signed by Owner ❑ Tr°at Number and Nemo(Mnlor Subs only( Cl <br /> Adqabdng Propmry Owner Names on Mnp Er <br /> All Lob Numbered 6^ <br /> Contour Llnef Location of Well and Septic System <br /> Excavations <br /> nodnmellon Plan and Schedule <br /> ❑ Flnanctai Guaronlas ❑ <br /> Cwvsedlom D Elevation Calw13lnllon Schedule <br /> Typical <br /> Enginaer'f Stamp ❑ <br /> D-hn .- 3 l-9'� <br /> Completed By: <br /> appnw.nn <br />