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E <br /> Town of � f <br /> �as� �� fA ... , <br /> ■ <br /> APPLICATION <br /> A; <br /> •.. '• <br /> PLAN <br /> Application Number <br /> REVIEW <br /> ti�Q .• ,. Checked oy Da e <br /> Applicant ►li.11owbend Club 428-2828 <br /> 0 Day Phone <br /> � 1-mGuth '�r 5 <br /> Aopitcani s Address y a I.-Road,ad, o toi t , _ J <br /> Representative(if any) -Dan i e1 C . uostetter pay gone —2828 <br /> Recresentattve'S Address above <br /> 4 y ( op c3 1 L e all I us t pay Phone- 112{ r 2.2E <br /> PrDCert Owner 1f other Shan a �r nt �Q�r �u � '` -rust '' 8 �.�.�,..._�.��. <br /> r'. <br /> Owner's Address above <br /> Pease indicate it all correspondence is Iv oe sent !o the aooilcar.t the recresentative , the oropemy owner. <br /> wrot oo you want to Co? <br /> what is your final goal's Put construction trazlor on site <br /> Pro!ect Address Quinaq uis s et Avenue T-.?ash-oe e <br /> Name of tract.development or ousiness 1f i l l o:orb end Club <br /> Legal pescription: Lot 18 ...�... Black 'rap; <br /> ASSeSsor'S Parcel Numoer Ma'n 6Q Plot 29 <br /> P,nSPnt;cnei G P Designation has! Cl"ential <br /> APPLICANTIREPRESENTATIVE: f nave reviewed this =orm. PROPERTY OWNER/AUTHORIZED AGENT: i have •,te's7 <br /> oierec aool+catton and the attacned material. The intormat!on -,ro. comofeted amication an❑ :;n5ent to its filing. <br /> vicec is accurate. I unaerstan❑ the city -nognt not aparave .vita[ !"-n <br /> aec+v=ng tor. or Migrnt set conditions of acoroval. <br /> r <br /> F S+�reC ❑ate 7 <br /> aie <br /> y N'� <br /> 01 <br /> y <br /> :r <br /> fi Received by Date 'Receipt Na <br /> p <br /> Permit avoroved by Date <br /> f <br /> Comments <br /> .R 4 <br /> •rt: �rA. - <br /> •^ <br />