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17 <br /> =16=.TX=00-& 0=1 e IT <br /> 1. Is the project site Included on the "Hazardous Waste and Substance Sites List" or other similar list? <br /> NO <br /> 2. Is the proposal an application for a development permit as defined by State law? <br /> Ifyou're not sure how to answer these questions, please ask a staff member for assistance <br /> I, the undersigned, do hereby certify that I have read and understand the attached cover <br /> sheet(s) and that the facts and information contained in this application are true and <br /> correct, to the best of my knowledge. <br /> Signature Applicant/Agent Signa re of Owner(s)* <br /> /;1.4,e/A- f"c r uso� <br /> Please prin igned name here Please pri signed name here <br /> a i O <br /> Date Date <br /> • All property owners must sign or provide a signed Agent Authorization Form included in <br /> the application packet. (If more space is needed for signatures, please attach <br /> additional sheets). <br /> Application Fee Design Review <br /> General Plan Designation Initial Study <br /> Zoning District State Clearinghouse Review <br /> Notification Fee Development Committee <br /> Total Fees Paid Concurrent Applications <br /> Referral Date Application Numbers <br /> Comments Due Date Public Hearing Date <br /> • • `1*14101wimmme Mel <br /> h:\cdd\odminishaffve approval appllcaflon 2000 <br />