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SITE PLAN FOR PROPOSED DEVELOPMENT IN MARION COUNTY <br /> <br />Property Owner: <br />Situs Address: <br /> <br />Block: <br /> <br />Su~v~ion:_ <br /> <br /> I certify that the above information is accurate to the best,9,LLmy knowledge. <br /> Applicant (Please Print) ~..//t/g~,~ ~. .~"~+ ~ Phone' <br /> <br /> ........ ~- --_-~__~ - l_~_ ........... <br /> FOR O-~ E~B ONLY <br /> PLrBLIC WORKS: Date: .... <br />MC: 15-60 BUILDING INSPECTION: Date: <br />Rev, 11/9] <br /> <br /> <br />