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54iZ1/20@3 15:@6 7197380983 - - M9 FbReS'f PAEiE @~ <br />t,e~at uesw~p~wn ox >atM OQ wttsclf aCttiCr1 iS prepared: {attach tcgal desctipfl4A ID the applilicatioa) <br />Existing Zoxnnp pisiziet(s~; rta <br />Prtpoxd New Ai9Fries{a): ~,_ <br />N>~sber o£&>~qag Lou: ~_ <br />I4ornbcr of I'soposed Lots: t...3A. <br />N~esr of Pmpoaad Dwettia~ Units: NA , <br />Averaga lot ~: ALA <br />If a Vai16nCC ~~, Re44~)3,1 fOx ttAC <br />trne'ianee(s}: i~ <br />Is at1 of a portion v£ ttx buiktinft aiRe Iozated i» n p4sartzal floodpt3io o. slot <br />with sioprs lut excess of twenty paaut: .g2_ (yes or tsa) <br />I£yes, which ofzheae coniditioas esast ' <br />value o£pmpoaczj naw catsstncCwn: - -- <br />Wilt sLe pxa~poaed pxojst xoquim Px0' sta~tt or federal pcemit6: „Q a (yes or tto) <br />If yrs., state which psxfttfits or appmwals are ralutCed <br />If a H,B. 104 t pextgix iGS xr+quApd, for what asatters of local rArlrersl 0nd srsxe iatetist:,,~_ _ <br />.4,dd111G~1 pCtip06t #IfoxtA8t10a: - ---_~ <br />5. CERTIFFCA'I'IOAi BX x)iI1; AAPI..ICANT: <br />t herehy ssste that this application is saadc with fish lmawlcdge a£ the ,aesigo stsnstards, ail free. <br />proce~ca, pabTic and nfteting ~~ decisit+n CriRari9 and o[bidt prOVisvas sustcaisKd <br />in die h(ucrfano Corv,ty fard Devrtopsnent Cnr' a pticab)e t4 this sgtplication: <br />Signature of AppEiretit: ^4t<e:,~.=~ / <br />6. ACTION: <br />Foal approrostl, wndiGonil approval or deabf t>ti I#Ie authorized perrnirsitt~t 2utltoroty: <br />^ ~ D <br />xsn,r <br />C Kf+r~s~~ili _ <br />xRk „~.~ <br />Paste 288 <br />