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SITE PLAN FOR PROPOSED DEVELOPMEN'I <br /> t <br /> <br />T <br /> <br /> Lot. <br /> <br />.i,,-,,,,,!........~. ................ ~,........~ ..... <br /> <br />Block: <br /> <br /> No. Acre. s: <br /> <br />..... v~,,,.--.-?-.--.,,,i,,,,,,,' "'-".--.,~..-.-'.-i-.-"',*,,,,,,,,i"---'-'+.'"""! ........ <br /> <br />MC: 15-60 <br />Rev. 11/91 <br /> <br />I certify that the above information:: accurate to the best of my <br />Applicant CPlea.se Print) ../t~'-t ~ <~..~{_~.k.C <~h,"~hJ*-~ --~-~g ,, <br />MailingAddre~s: ":¢"~'Z'~,,, k,O,~-2~-* .~ ~¢~'- <br />Applicant's Signature: ~' )-~ ~ . <br />.......... --T 70~ ~,~ ~--~'r~---- <br />PLANNING: Date: <br />PUBLIC WORKS: Date: <br />BUILDING INSPECTION: Date: <br /> <br />Phone: ~ ~ ~ - t ~ [ / <br /> <br /> <br />