Laserfiche WebLink
GENERAL APPLICATION INFORMATION <br />1. Name, mailing address and day phone of land owner(s) of record: <br />Landowner(y) signature(s) required on application form. <br />Name: 2t LAK -s-,:) Z Lri7,tPANIV LLL <br />Mailing Address: D . &Y- toll <br />City/State/ZIP: f C DsLy -i , L' -L i Sq2 2.. <br />Day Time Phone: <br />Email Address: <br />2. Name, mailing address and day prone of authorized agent, if different from landowner of record: <br />If an authorized agent is indicated, then the authorized agents signature is required for application submittal. <br />AgentName: G4 % lvl jj EJ3 Z.-XAQJ!�� LZ -e!, <br />Mailing Address: //'/0(7}r� <br />City/State/ZIP: <br />Day Time Picone: -&9-6-74-72-7 �.�1 <br />Email Address: J LRA-1/� ! y 7 ! ,0(-1106 LLd , <br />3. Name, mailing address and day phone of other contact person <br />If different than land owner or authorized agent. <br />Name: Il l a j? ' j <br />Mailing Address: X 4 `, <br />City/State/ZIP: U uyy) , liLll t q <br />Day Time Phone: SLA - 6-4--7) % 1 <br />Email Address: J &-k LV (2, M a R -r eL4[ P, <br />4. Street address of property:! j <br />Address: <br />City/State/ZIP: <br />5. Legal description of property (attach additional sheets as necessary): <br />-(-'F-0- A T-rALhe--b <br />5. <br />7. <br />8. <br />4 <br />Tax parcel number: SEf-;:; , -T—t/ <br />Property size: 445.42 AL. (acres) <br />Land Use Information: POD Zoning: O L) o Comp Plan Land Use Designation_ PVD <br />Page 2 of 3 <br />