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GENERAL APPLICATION INFORMATION <br />1. Name, mailing address and day phone of land owner(s) of record: <br />Landowner(s) signature(s) required on app lication form. <br />N ame: <br />Mailing Address: <br />City/State/Z IP: <br />Day Time Phone: <br />Email Address: <br />'EM.'TZ:)U R1 O&,tL L.~ t!011A..PA~Y L,Lf!_ <br />?. D . 6 D-x. fo(d"9- <br />2. Name, mailing address and day phone of authorized agent, if different from landowner of record: <br />3. <br />If an authorized agent is indicated, then the authorized agent's signature is required f or application submittal. <br />Agent Nam e : <br />Mailing A ddress: fJ o -<3ov 4s2 <br />City/State/ZIP: <br />Day Time Phone: 5:D°l-fa74-727 l <br />Email Address: <br />Name, mailing address and day phone of other contact person <br />If different than land owner or authorized agent. <br />Name: J~RR. Y fl1ait'.,W,6 <br />Mai ling Address: Po 6 a x458 <br />City/State/ZIP: <br />Day Time Phone: <br />E mail Address: <br />4. Street address of property: <br />5. <br />6 . <br />7. <br />Address: <br />City/State/Z IP: <br />ex: :rEtUSi ~ v"'l D j:: ft; ta.dtw u.1-v <br />"fA.=) TDV\ I WA._ <br />Legal description of property (attach additional sheets as necessary): <br />£2 'lE.iL A TT .ALY\ ffi <br />Tax parcel number: _____ S-=..c\E=f£=z::,'--"-A---'' :.....:1'---1:....:.A/:,,-=-v-'-}l)={:;::....~=-------- <br />Property size: ________ 4_:__4..::.=5 =----. 4--=-=2=--=A___:.::C=::....:..... ______ (acres) <br />8. Land Use Information: <br />Zoning: __ {)~o~D~---Comp P lan Land Use D esignation: __ P_U_}_[) ____ _ <br />Page 2 of3