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li <br /> APPLICATION CONTROL SHEET <br /> �sv <br /> WWI,!€P.1 ly £ ZI' rs {, rr�bn loin{{,(olbd Is++,,sUeilelJ In�`nl Sn{ye 516�� k i s: y +3viT,sSS <br /> ProApp Only: OYos ❑ No roe: flocalpl Numbat: Dole: <br /> rlloNumbot: Ms roe: I flocolplNumbor, 10193 Dole:(A18'o <br /> rllo Numbor, roe: Nocolpl Numbot: Dole: <br /> Pilo Numbor. roe: flocalpl Numbot Dnlo! <br /> Doscrlpllon of Projocl U tJ /h M 1 rJ >01 V1 SI dl b-1oP�l G/<C1 c.,3 T-,& <br /> '5,,J19,0 M t2-- p, 1.32 Qc.2= PA;y-c-Z I rITL", 4--vV- (S) <br /> PU2LctiS I <br /> 2- , 4 `ice cc-r,",,3 '7C-1oo 5Q f�T <br /> 7c-,-7b0 ± S<-•l i�(-. <br /> rro)ocl Locnllon: ori —k-r� <�-c--o-j - CXF UA-5,r <br /> M A,It-J SM-zv 101<t-:9z' <br /> Addross: ?j�()� �. "t"lrl SiIZ�.0 <br /> _ c C A -T52115 <br /> Oc110101 Hoot Couonuolly: [(�C�� -- -- Donomi rinn Doslgnnllon: <br /> 701111ig Mnp: rtopetty Zonhip: G-U Ovariny Zotw(s); <br /> Adjncar,l Ocnntnl rinn Zoning <br /> Norlb: ]Ztl R-L <br /> South: <br /> Enol: �I L s �- G �'L <-G <br /> Wcnt: - '----- f� L C 'U r�--L f C <br /> too Yon,rlood ❑ yes No WOlimuson Act ❑ Yes '610 I Suparvlsotlol District: `L <br /> AhpmlArcn: NU> Speclllcrinu(s) ❑ Yes 9(-No: <br /> 1112101y: <br /> b{a{fsS (sis9c 1. <br /> t tl P of. f c)ic(cLlstd ,t� <br /> .t.... :.& � ...:. £ s i:;:s` �e..�•. 3.,, ._;xi£.!)s.Ys$� 2 .:... ?. f'R3fsf��, <br /> All Appllcellons <br /> Completed Appllcollon roans Owners'Signature <br /> Copy of Dood or rtolludunty nio nepott• ❑ Copies of Pion or Mnp <br /> 0'/3'x I I'IlodUcod Moor or Mop I I Inzordous Mnlodals Dlsclosuto Survey ❑ <br /> Dovolopmenl Impncl Mlllgnllon roe rotor, ❑ Assessor end I Ilolory Pops <br /> Nomos List• Sowor/Welor'WIII Servo'Letter ❑ <br /> 1 <br /> Guumnl Ants Mnp• ❑ Zoulrrg Mop• ❑ <br /> Sells flopott• ❑ Salts Sultroblllly Study ❑ <br /> Subsldm,co Arco ❑ yes Pio rxponslvo Sell Area yes ❑ No <br /> • lhceo mntctlnis cony not be Roquhed for corleh,nppllcallons. Chock the nppllcn(lon typo for dotnlls. <br /> Tentnllvo Mnps <br /> 1,101)Signed by Owner Trutt Humber and Nnrno(Mojor Subs only) ❑ <br /> Adjoining Properly Owncis Nnmcs on Mnp All Lob Numbotad <br /> Conlour Lincs X Locnllon of Well end Septic Syslam ❑ <br /> E-ormnllmss <br /> floclmmrollon Plon and Schedule ❑ rinmtclnl DummUoo ❑ <br /> Typlcnl Ctosrooctlmrs ❑ Elovnllon Cnlculnllon Schodulo ❑ <br /> 6rglnacr's Slnmp ❑ <br /> CongdoloJ Ely: ( .,,A DE Lr�, 7bRrt,r 93 <br /> r. r.nu - <br />