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FOR, OFFICE USE ONLY <br />Received By:~*~ <br />Zoning V lid io <br /> <br />~ii'~EVALUATIONAND/ORSI~PTiCPERMITAPt~LICATIOI~!~I~hI~': x(' ~ , <br /> <br /> S~ Sys~m mom {h~ 10~ ~1, D~: <br /> <br />.... ~oldi~R T~k ~ ~5,00 10~0 <br /> <br />~Ot eaeh ~dj~ional 5~ ~&l, D~F 25,~ <br />~ Mino~ 75.00 10,00 <br />~ng Sys~m Evil.on Repofl r 150-~ 10,~ <br />Autbod~on N0~e (~M Vt~dt) 150_~ 10.00 <br />Auiho~t~n N~e ~o F~Id Vide) ' ' 85.00 10,~ <br />Aauua Evalu~ion ~o ~ se.~ 10.~ <br />~r <br /> <br />( M~ it App llcabk Iv thh ^pplk.~tou) .. . <br />( ) I will c~lt when Tc~i Hol~I Dug <br /> <br />'I~SI~EV ~93 <br /> <br />NAME 01~ APPLIC.~IT (please print): <br />SIGNATURE OF APPLICANT: <br /> <br />DATE:' <br /> <br /> <br />