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_ ~ ;~..: ~. j x - _ R~ 3 ~S <br />hPR~E/DANA,{Pars anttoSection-5210D:2e) "y~~~_, ~a. ,r ~ ~,. ~, ~~'. <br />Written Description of Project: Attached in Narrative <br />Proposed Land Use Tvoe # of Lots # of Units Acreaoe Floor Area Ft2 <br />Single Family <br />Duplex <br />Multi-Family <br />CommerciallOffice <br />Industrial <br />Other: <br />Total Project: <br />Proposed Zoning (for Zone Change only): <br />Proposed/existing (circle one) Access; <br />Proposed/existing (circle one) Source of Water: <br />Proposed/existing (circle one) Source of Waste Disposal: <br />Proposed/existing (circle one) Fire Protection: <br />Existing Zoning: Resource <br />Existing Land Use: Resource and Recreation <br />Date of Parcel Creation (for Exemption Plat only): <br />~ ~ ~~VICINITY MAP ATTACHED (Pursuant to Section 5-210.D.2.d). <br />~ ~ ~ QNVIRONMENTAL IMPACT REPORT ATTACHED, IF REQUIRED (Pursuant to Section 5-210.D.2.f). <br />~ ~ ~~ADDITIONAL REQUIREMENTS ATTACHED, IF REQUIRED (Pursuant to Section 5-210.D.2.g). <br />Signature of operty Owner or Authonze epresentative Date <br />I do hereby certify that the foregoing representations and attachments are true and.correct to the best of my <br />knowledge. <br />~OFFICAI'USEONLY ~ 3..~ ~T ~~~~ «»= ~ ~~' ~ c,~ ~ r~ ~ ~,~ <br />- __ z i• ~, u ' K <br />Received 8y: Date: <br />Amount Received: $ Receipt #: Check #: <br />