72-8Ul) A)
.- c)
*For office use onl,y ,
*REVIEW BY P.C. .
':~PP:E'iCA~IO?. TO THE BOARD OF SUPERVISORS
TELEPHONE NO.: ~-
D) NAME OF PRESENT OWNER OF PROPERTY ON WHICH THIS REQUEST WILL
OCC UR:
~) ~HO.~ NO.: ~A ~ - ,~ O ~q, ,
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)
A) MAGISTERIAL DISTBICT '~$;j~y~ /j~kl.y, B) TAX MAP NO. ~--il
C) SEC. NO. i"~ D) SUBDIVISION NO. ~ E) BLOCK NO.~"--
F) L~ OR PARC~ NO.
A PLAT O~ TaIS PaOPER~Y SaAL~
LOCATION BY REFERENCE TO NEAREST ROAD INTERSECTION
DIMENSIONS OF SITE
(PAGE 1)
4)
5)
EXPLAIN ~3LLY THE TYPE OF USE PERMIT REQUESTED:
STATE THE REASON FOR HIS REQUEST:
6)
STATE H0W THIS REQUEST WILL NOT BE MATERIALLY DETRIMENTAL TO
THE ADJACENT PROPERTY OWNERS OR THE S~RROUNDING NEIGHBORHOOD:
7)
STATE A~ EXISTING USE PERMIT OR VARIANCE 'GRANTED PREVIOUSLY ON
T..HE...,~pARCEL IN QUESTION:
8) A) .... E'XIE'TIN8. L~ND USE:
B ) .... ~-X'ISTINO ~ ZONING:
(PA~E 2)
9)
GIVE NAMES OF ALL OWNEP~ ADJACENT, ACROSS THE ROAD OR HIUHWAY
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 OF ANY ROAD OR HIGHWAY WITH A RAILROAD RIGHT-
OF-WAY OR AT OR WITHIN ONE HUNDRED FEET OF THE INTERSECTION OF
...THE RI(]HTS-O~-WAY OF ANY TWO RAILROADS, GIVE NAMES OF PROPERTY
OWNERS AT ALL COR~ERS DP ANY SUCH INTERSECTION.
B) PROPERTY OWNER' S NAME
MAILING ADDRESS:
¢)
D~
T~ MAP NO,:~// SEC. NO,:.~ SUBDIVISION NO,: ~Z3' "
BLOCK NO.: _ ~' ...... LOT OR PARCEL N.O.:
MAILING A~D~SS: /~ ~ ~& ~ ~1
SLOO~ ~0.: ~'~ '0~ ~CZL ~0. :.
TAX ~P ~O.: SEC. NO.: ~ S~D~V~S~ON' NO.:
B~CK NO.: LO~ OR PARCEL ~0.-
(P,.AGE 3)
E)
P) 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.:
BLOCK NO.:
SUBDIVISION NO.:
LOT OR PARCEL NO.:
H) PROPERTY OWNER'S NAME:
MAILING ADDRESS:
TAX MAP NO.:
BLOCK NO.:
SEC. NO.: SUBDIVISION NO. ·
LOT OR PARCEL NO.:
I) PROPERTY OWNER' S NAME:
MAIL~G ADDEE$$.~ ....
TAX MAP MO.:
BLOCK NO.-:
SEC. NO.: _ . , ~SUBDIVISION NO.:
LOT OR PARCEL NO.:
PROPERTY OWNER' S NAME:
MAILING ADDRESS:
2AX MAP NO.: SEC. NO : SUBDIVISION NO :
BLOCK NO. :,. ,., , LOT OR PARCEL NO.:
(PAGE 4)
/
THE APPLICANT HEREWITH DEPOSITS THE SUM OF TWENTY DOLLARS
(~) ATTacHED TO THIS APPLICATION, TO PAY THE COST OF
ADVERTISING NOTICE 0F THE HEARING OF SAID BOARD TO AOT ON
THIS REQUEST. CHECK OR MONEY ORDER MUST BE MADE PAYABLE
TO: ~REASU~.E~, CDUNTY OF CHESTERF!E%D.
I/WE HEREBY DEPOSE AND SAY THAT ALL OF THE ABOVE STATEMENTS
AND THE STATEMENTS CONTAINED IN ANY EXHIBITS TRANSMITTED ARE
TRUE.
(Same name as
page 1. )
[item l-A,
(PAGE 5)