72-6U:For office use~n~.n~
*CASE NO.
*REVIEW BY P. C.
APPLICATI02 TO THE BOARD OF SUPERVISORS
1)
2)
3)
A) NAME OF APPLICanT:
B)
c)
v)
E)'
MAILING ADDRESS:
~A~ OF P~SENT OWNER OF PROPERTY ON ~mICH THIS ~Q~ST WILL
MAILING ADDRESS:~
TELEPHONE NO.:
IF THE APPLICANT IS NOT THE OWNER OF THE PROPERTY IN QUESTION.
EXPLAIN: (Copy of pending contract or opti~n agreement shall
be attached hereto and made a part of this ~pplication. )
~, IS ~~~ .
LOCATION OF PROPERTY IN QUESTION
(Following information to be obtained from the
Offioe of the County Assessor)
A) MA~IST~RI^L DIST~I~T ,.~'~j-~ ~//~ B) TAX MA~.~O. ~,?-~(~J
¢) SEC. NO. _/~.~ D) SUBDIVISION NO. ~~E) BLOCK NO
F) LOT OR PARCEL NO.., / .__ O) STREET ADDRESS /~/~ ~~g~
A PLAT OF THIS PROPERTY SHALL BE ~TTACHED HE.TO AND MADE A PART
OF THIS. APPLICATION SHOWING THE FOLLOWING:
LOCATION BY RE~RENCE TO NEAREST ROAD INTERSECTION
DI~NSIONS OF SITE
( PA G~. l)
EXPLAIN PULLY THE TYPE OF USE PERMIT REQUESTED:
5) STATE THE REASON FOR THIS REQUEST: ~'/,~ ~"/z'.~4' ,,'~'.e~,~'.~'/f'~ ,F//~
6) STATE HOW THIS REQ~ST WILL NOT BE ~RIALLY DETRi~AL TO
THE ADJACENT PROPERTY OWNERS OR THE SURROUNDING NEIG~ORHOOD:
7) STATE ANY EXISTING USE PERMIT OR VARIANCE GRANTED PREVIOUSLY ON
THE PARCEL IN QUESTION:
8) A)
B)
EXISTING ZONING-~
( PAGE 2)
9)
GIVE NAMES OF ALL OWNEP~ 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 MORJE ROADS OR HIGHWAYS, AT OR WITHIN ONE HUNDRED FEET
OF THE INTERSECTION OF 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: ~//~;~,4~/,'~'~ ~ ~,,~'zSz~,~',C~
MAILING ADDRESS.: /J/~
TAX ~P NO. ·: ~ S~DIVISION NO.: ~r~
B~OCK NOs: ~ ~ ~OT OR PARCEL NOs: ~1
B). PROPERTY OWNER'S NAME: . ~"~'~/F~ ~,'/~/.
~ILING ADDESS: ~~
TAX MAP NO.: J~EC. NO.: ..... S~DIVISION NO
BLOCK NO. ~ . ~ _ LOT OR PARCEL NO. :.. /- /
C) PROPERTM OWNER'S NA~: /~ ~
MAILING ADDRESS: ?~ ~'~ ~~~ ~ ~,
TAX ~P NO.: ~-~EC. NO.: - ~ SUBDIVISION NO :
BLOCK N0.: .~ .' '
D)
LOT OR PARCEL NO.-
PROPERTY OWNER'S NAME:.~,/,,~,,~/C~ ~, ./~Z'.,~"'4'""~"..~',A~..~ ~'/~,
MAILING ADDRESS :.
TAX MAP NO. :.Z~EC. MO.:
BLOC NO.: 0 LOT oR P^RCEL NO. :.. , ,
(PAGE 3)
E)
TAX MAP ~o. :,~.~ ~'~y SEC. NO. :, ~, SUBDIVISION No.: ,~.~k~r~
BLOCK NO,: ~ ~LOT OR PARCEL NO,: ~..~"'~-z'~z>/~'~ ,
PROPERTY OWNER'S NAME:
G)
H)
MAILING ADDRESS:
TAX MAP NO. :,,, SEC. NO.: SUBDIVISION NO :
BLOCK NO.:
LOT OR PARCEL NO.:
PROPERTY OWNER'S NAME:
MAILING ADDRESS:
TAX MAP NO.:
BLOCK NO.:
SEC. NO.:, SUBDIVISION NO.:
LOT OR PARCEL NO.:
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.:
LOT OR PARCEL NO.:
J)
PROPERTY OWNER'S NAME:
MAILING ADDRESS:
TAX MAP NO.:
BLOCK NO.:
SEC. NO.: SUBDIVISION NO.:
LOT OR PARCEL NO.:
(PAGE 4)
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 AOT ON
THIS REQUEST. CHECK OR MONEY ORDER MUST BE MADE PAYABLE
TO: TREASU~ER~ COUNTy OF. CHESTERFIELD.
I/WE HEREBY DEPOSE AND SAY THAT ALL OF THE ABOVE STATEMENTS
AND THE STATEMENTS CONTAINED IN ANY EXHIBITS ,TRANSMITTED ARE
TRUE.
197/
SIGNATURE OF APPLICANT ' --
(Same name as used in item i-A,
page 1. )
SUBSCRIBED AND SWORN TO BEFORE ME THIS...~ DAY OF __ ~z~c~
19~.
MY COMMISSION EXPIRES /~ f 7 t9~.'~. ,~~~,--~_ ~ ~/
~, ~- ~-~ ~.~'
~TARY -
(PAGE 5)