72-6U FOr office use~nly
*CASE NO.
,
*REVIEW BY P. C.
,
APPLICATION TO THE BOARD OF SUPERVISORS
Th~ fol!owtn$ info~mation is to be typed or printed
1) A) NAME OF APPLIC~'~T:
B)
c)
D)
E)'
MAILING ADDRESS:
TELEPHONE NO.:
NA~ OF ~SENT OWNE~ O~ ~ROPERTY ON WHICH THIS REQUEST WILL
OCCUR: ,,. -~"~/~, A'
MAILIN8 ADDRESS
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.)
z: ,,/~ ~,~,'~ .......
3)
LOCATION OF PROPERTY IN QUESTION
(Following information to be obtained from the
Office of the County Assessor)
A)
MAGISTERIAL
///L~ B) TAX ~AP NO.
DISTRICT
C) SEC. NO. _~ D) SUBDIVISION NO. /~/~. ~E) BLOCK NO.
F) LOT OR PARCEL NO. / __ G) STREET ADDRESS
A PLAT OF THIS PROPERTY SHALL BE ~TTACHED HERETO AND MADE A PART
OF THIS, APPLICATION SHOWING THE FOLLOWING:
LOCATION BY REFERENCE TO NEAREST ROAD INTERSECTION
DIMENSIONS OF SITE
(PAGE 1%