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SITE PLAN MUST SHOW ALL PROPERTY LINES AND DIMENSIONS <br /> ❑ Drawn to Scale: 1 square= Feet Not Drawn to Scale:Total Acres <br /> ..J2SZ._ \ (--\%-9.-8, <br /> I certify that the above information is accurate to the best of my knowledge. I AM THE [ ] Owner g Authorized Agent <br /> Name(please print): , <br /> "Apr CR My telephone number is: 50.5 - 950 "'7�� <br /> il'� <br /> Applicant Signature: "/ %�' '/I�� Date: � ®/9 <br /> Irr <br /> Applicant's Mailing Address: T'9�Ff3 AeSeeitie City: ( v1 Zip: y ,3/? <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 />