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SITE PLAN MUST SHOW ALL PROPERTY LINES AND DIMENSIONS I� <br /> ❑ Drawn to Scale: 1 square= Feet Not Drawn to Scale:Total Acres <br /> kbIA .'")[ 1r <br /> . . <br /> • <br /> I certify that the above information is accurate to the best of my knowledge. I AM THE [x Owner [ ]Authorized Agent <br /> Name(please print): D K.) // S My telephone number is: 5 D3 Li 5 <br /> Applicant Signature: I71)1'D (',V\ s �J/�l r1.(Q p1 Date: 3-7 - <br /> Applicant's Mailing Address:P o , Ue)K. d D City: VA ``b In o 1 l Zip: C 0-7 i) <br /> FOR OFFICE USE ONLY <br /> PLANNING: Date: <br /> PUBLIC WORKS: <br /> BUILDING INSPECTION(Acceptable for Planning requirements only) Date: <br /> Page 4 of 5 <br /> A-33D <br /> Rev.05/2011,09/2012 <br />