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<br /> <br />BOARD OF ADJUSTMENT APPLICATION <br />CONDITIONAL USE PERMIT <br />NAME OF APPLICANT: _ PARK trDUNTY R0.4Q AN4 dJR//J GE .DEPT" <br />MAILING ADDRESS: / O. /y ~ <br />CITY: FA/RP.(/4Y STATE: Go ZIP: g0~'4'D <br />TELEPHONE WHERE YOU CAN BE REACHED: C9~v) 8:35- H2 fs3 <br />GROUNDS FOR REQUEST:III:S:b:6, ,WE ~4RE f-lvf,~v/n/G FoR i1 <br />,~(/M/rJE'O ~MP.fG T OPER,4 <br />T/ <br />ON ~/ <br />/O ~jIEC~AMiI-7'/ON F~ER/~ /T <br />~A/p A CO//D/ ' <br />/ <br />T/O NR,C G1cSt p <br />/ ER M/T ~S A JPE OU/APE MENT <br />R T Y Wi< <br />!-o R <br />O <br />NcE <br />In order to process your application, the Board of Adjustment <br />must have the following information in its file thirty-five (35) <br />days before you r. hearing date (the Board meets on the third <br />Tuesday of each month): <br />~ Proof of ownership of property (warranty deed) <br />- Non-refundable filing fee in the amount of 5125.00 <br />A plan showing exisitng and proposed uses <br />I certify that I am the applicant named above and that the <br />information contained 'herein is accurate to the best of my <br />knowledge and belief. <br />Signature of Applican Date <br />NOTE: YOUR APPLICATION WILL NOT BE PLACED ON THE AGENDA OF THE <br />BOARD UNTIL IT IS COMPLETE. <br /> <br />