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SITE PLAN FOR PROPOSED DEVELOPMENT IN MARION COUNTY <br />Property Owner: ~ .a ~ <br />Situs Address: ~__ <br /> <br />Lot <br /> <br />Block:__ Subdivision: <br /> <br />TaxAccount #:/- -56~}/-000 <br /> <br />Zone: Map: <br />s~c: .~o T 0~ ~ge: /ti) <br />No. Acres: /, <br /> <br />I certify that the above information i.~ a~_m'a.!.e to ~e b~st~ my knowledge. <br />Applicant (Plea~e Print) -Z~E3~ ~ ~ I~t~ I e_ Phone: <br />Mailing Address: .>-~ g'/ /,~ . ~ ,E. ' <br /> <br />Applicant's Signature: - r~ Date: <br /> <br /> FOR OFFICE USE ONLY <br /> <br />Da~e: <br /> <br />PLANNING: <br /> <br />PUBLIC WORKS: <br /> <br />MC: 15-60 BUILDING INSPECTION: Date: <br />Rev. 11/91 <br /> <br /> <br />