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CERTIFICATIONS <br /> Is this project site included on the "Hazardous Waste and Substance Sites List" or other similar list? <br /> �CD <br /> Is the proposal an application for a development permit as defined in State law? 1��n <br /> SIGNATURES <br /> I, THE UNDERSIGNED, DO HEREBY CERTIFY THAT I HAVE READ AND <br /> UNDERSTAND THE ATTACHED COVER SHEET(S) AND THAT THE FACTS <br /> AND INFORMATION CONTAINED IN THE ABOVE APPLICATION ARE TRUE <br /> AND CO T, TO THE BEST OF MY I<a OWLEDGE. <br /> SIGNATURE OF APPLICANT/AGENT *SIGNATURE OF OWNER(S) <br /> /D 17 f--v <br /> DATE DATE <br /> 'ALL PROPERTY OWNERS MUST SIGti (IF MORE SPACE IS NEEDED,PLEASE ATTACH A SEPARATE SHEET) <br /> DATE RECEIVED: /Q ZONING DISTRICT: <br /> APPLICATION NUMBER: ( RECEIVED BY: <br /> APPLICATION FEE. RECEIPT NUMBER: <br /> ! ENVIRONMENTAL REVIEW FEE: a�Js. INITIAL STUDY: <br /> NOTIFICATION FEE: DEVELOPMENT COMMITTEE: <br /> TOTAL.FEES: � CONCURRENT APP.NO.: <br /> OFFICE USE ONLY <br /> cn <br /> 4 <br />