72-3U--"~:.,~ APPLICATION
1) A)
B)
C)
*For office use/~nly
*REVIEW BY P.C. ,-- ,..
TO THE Bf.,~S3
The followin$ information ,is to pe typed pr printed
D) NAME OF PRESENT OWNER OF PROPERTY ON WHICH THIS REQUEST WILL
OCCUR:
E) MAILING ADDRESS: ~'~Z~ ~c~
F) TELEPHONE NO.: . ~'"~,~'~
2)
IF THE APPLICANT IS NOT THE OWNER OF THE PROPERTY IN QUESTION,
EXPLAIN: (Copy of pending contract or option agreement shall
be attached hereto and made a part of this application.)
3)
LOCATION OF PROPERTY IN QUESTION
(Following'information to be obtained from the
Office of the County Assessor)
C) SEC. NO. ~ D) SUBDIVISION NO: E) BLOCK NO.
F) LOT OR PARCEL NO. ~-, G) STREET ADDRESS ~O PO~OO b~._
A PLAT OF THIS PROPERTY SHALL BE ATTACHED HERETO AND MADE A PART
OF THIS APPLICATION SHOWING THE FOLLOWING:
LOCATION BY REFERENCE TO NEAREST ROAD INTERSECTION
DIMENSIONS OF SITE
(PAGE 1)
GIVE NAMES OF ALL OWNERS ADJACENT, ACROSS THE ROAD OR HIGHWAY
AND FACING THE PROPERTY AND ANY OWNERS ACROSS ANY RAILROAD RIGHT_
OF WAY FROM SUCH PROPERTY. IN THE EVENT THE PROPERTY AFFECTED
IS SITUATED AT OR WITHIN 100 FEET ON THE INTERSECTION OF ANY
TWO OR MORE ROADS OR HIGHWAYS, AT OR WITHIN ONE HUNDRED FEET
OF THE INTERSECTION O~ ANY ROAD OR HIGHWAY WITH A RAILROAD RIGHT-
OF-WAY OR AT OR WITHIN ONE HUNDRED FEET OF THE INTERSECTION OF
· THE RIGHTS-OF-WAY OF ANY TWO RAILROADS, GIVE NAMES OF PROPERTY
OWNERS AT ALL CORNERS OF ANY SUCH INTERSECTION.
A)
PROPERTY OWNER ' S NAME:
MAILING ADDRESS: ~,~, ~O PdO~¢~
TAX MAP NO.: I~- I~ SEC. NO. :_A . SUBDIVISION NO.:
BLOCK NO.: F, ,. LOT OR PARCEL NO.: .
B)
C)
PROPERTY OWNER'S NAME: ALL~-~"J
MAILING ADDRESS: /~ P~~O
TAX MAP NO.:~q-/~ SEC. NO.: ~ SUBDIVISION NO.:
BLOCK NO.: C LOT OR PARCEL NO.:
MAILING ADDRESS: U/~~-+ L~ ~ ~,%~~&/~
BLOCK NO.: LOT OR PARCEL NO.: ,~
D)
MAILING ADDRESS: j'Oj,~ 2~,~O ~,(~,
J )l s c. No.- SUBDIVISION NO:
TAX MAP NO.: .... . .
BLOCK NO.: ~ LOT OR PARCEL NO.:
(PAGE 3)
4)
EXPLAIN FULLY THE TYPE OF USE PERMIT REQUESTED:
5)
6)
STATE THE REASON FOR THIS REQUEST:
~ ~ Dos ~",-,~...r, , , , , , ,
STATE HOW THIS REQUEST WILL NOT BE MATERIALLY DETRIMENTAL TO
THE ADJACENT PROPERTY OWNERS OR THE SURROUNDING NEIGHBORHOOD:
7)
STATE ANY EXISTING USE PERMIT OR VARIANCE GRANTED PREVIOUSLY ON
THE PARCEL IN QUESTION:
8)
A)
EXISTIN~ LAND USE: ~--,.',..~ ~t_,'b d'/'-/D,":'.. L_
B) EXISTING ZONING:
ce-../)
(PAGE 2)
E) PROPERTY OWNER'S NAME:
MAILING ADDRESS:
TAX MAP NO.: SEC. NO.:
SUBDIVISION NO.:
BLOCK NO.:
LOT OR PARCEL NO.:
F)
PROPERTY OWNER'S NAME:
MAILING ADDRESS:
TAX MAP NO.:
BLOCK NO.:
SEC. NO.: SUBDIVISION NO.:
LOT OR PARCEL NO.:
G)
PROPERTY OWNER'S NAME:
MAILING ADDRESS:
TAX MAP NO.:
BLOCK NO.':
SEC. NO.: SUBDIVISION NO.:
LOT OR PARCEL NO.:
H) PROPERTY OWNER'S NAME:
MAILING ADDRESS:
TAX MAP NO.:
SEC. NO.:
SUBDIVISION NO.:
BLOCK NO.:
LOT OR PARCEL NO.:
I)
PROPERTY OWNER'S NAME:
MAILING ADDRESS:
TAX MAP NO.:
BLOCK NO.:
SEC. NO.: SUBDIVISION NO.:
iLOT OR PARCEL NO.:
J)
PROPERTY OWNER' S NAME:
MAILING ADDRESS:
TAX MAP NO.:
SEC. NO.:
SUBDIVISION NO.:
BLOCK NO.:
LOT OR PARCEL NO.:
(PAGE 4)
'10 )
THE APPLICANT HEREWITH DEPOSITS THE SUM OF TWENTY DOLLARS
($20.00) ATTACHED TO THIS APPLICATION, .TO PAY THE COST OF
ADVERTISING NOTICE OF THE HEARING OF SAID BOARD TO ACT ON
THIS REQUEST. CHECK OR MONEY ORDER MUST BE MADE PAYABLE
TO: TRE~AS,URER,~ OOUNTY OF CHES, TERFIELD.
I/WE HEREBY DEPOSE AND SAY THAT ALL OF THE ABOVE STATEMENTS
AND THE STATEMENTS CONTAINED IN ANY EXHIBITS TRANSMITTED ARE
TRUE.
SIGNATORE OF' APPLiCkNT
(Same name as used in item l-A,
pare 1. )
SUBSCRIBED AND SWORN TO BEFORE ME THIS
MY COMMISSION EXPIRES/~.~/~ /? 19~.
__DAY OF ~a-~ 19~,/~.
NOTARY
(PAGE 5)