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17 <br /> F4m� . ■ .■ <br /> r <br /> • /1� \M <br /> Town of Maslipee <br /> APPLICAFION <br /> PLAN Z <br /> /4 Application Numt>er <br /> REVIEW <br /> Checktd by fete <br /> `'A pp lira nt.. ,,.,_ li`.'�o 4k.2., _� -_- .. <br /> Day Phone <br /> -Applicant's Address <br /> �Representative it an � � <br /> Re �. <br /> p y) A Day Phone <br /> - r <br /> 'Representative's Address : _ _- <br /> Property Owner(If other than applicant) _ - - <br /> Day Phone � .�� <br /> Ir <br /> Owner's address /47 <br /> Please indicate if all correspondence is to be sent to the applicant the representative hprvpertYowner. <br /> What do you want to do? �- _ - �- <br /> What is our final pal. +`� L .��-� � `� �' ��� <br /> Proiect address <br /> [dame of tract, development or business J-71 C—u� <br /> ,Legal Description: Lot Black <br /> -Assessor's Parcel Number Present gone/G.P Designation <br /> APPLICANT�REPRESENTATIVE; I have reviewed this com• PROPERTY OWI`4ERMUTHORIZED AGENT: I have reac <br /> Meted application and the attached material. The information p►o. completed application and consent to its filing. <br /> � tCed is accurate, I understand the city might not approve .vha t I'm <br /> potyinq for. or might set conditions of approval. <br /> a'Gns!a Dale Si snap LOYDa <br /> Y Received by Date Receipt NcL <br /> `.1.c <br /> r Permit approved by _.. ._ .. _, .__, ..._.__..._..,,.,.- _„_. _Date <br /> . Comments <br /> �Y <br /> E:s <br /> 1 <br /> I <br /> S <br /> i <br /> 1 <br /> 1 <br />