72-34c1) ^)
B)
c)
D)
E)
F) ~.
2) IF T}
EXPLt
be at
3)
(~
^) M
C) SI
F) L~
*For office u/'~ only
, .......
T_he fo!l. owin$ information is to be _typed _or ..printed
IAME OF APPLICANT:
tAILING ADDRESS:
!ELEPHONE NO.:
E APPLICANT IS NOT THE OWNER OF THE PROPERTY IN QUESTION,
IN: (Copy of pending contract or option agreement shall
tached hereto and made a part of this application.)
, u,w/~ ~ ~ ~,~,, 7-,. ~ ~_o _~.;. ....
LOCATION OF PROPERTY IN QUESTION
)llowing information to be obtained by the applicant
from the Office of the County Assessor)
;C. NO. 3- / , D) SUBDIVISION NO. E) BLOCK NO.
,T OR PARCEL NO. 3-/ G) STREET ADDRESS
.A PLAT OF THIS PROPERTY SHALL BE ATTACHED HERETO AND MADE
OF TH~S APPLICATION SHOWING THE FOLLOWING:
iOCATION BY REFERENCE TO NEAREST ROAD INTERSECTION
~IMENSIONS OF SITE
(PAGE 1)
A PART
THE
REC]
5) s
6) STAT~
THE
7) STAT!
THE
~.Th~
8) EXIS]
PETITIONER REQUESTS THAT THE ZONING ORDINANCE BE AMENDED TO
~SSIFY THIS PROPERTY FROM ~'~l,~.~To~/ TO ~-/
I NO./NAME NO./NAME' '
THE REASON FOR THIS REQUEST: /''~o .~,~'~ (,-y ,~,u ~ ,¢" .r~,.~.o
, ,,-','~,~ .- ~,.'.: ~ z,4..,,,;,,..,4 ~.,.,,,,.,.,- ,~,.,-,4,',,7
HOW THIS REQUEST WILL NOT BE MATERIALLY DETRIMENTAL TO
~DJACENT PROPERTY OWNERS OR THE SURROUNDING NEIGHBORHOOD:
:ANY EXISTING USE PERMIT OR VARIANCE GRANTED PREVIOUSLY ON
ARCEL IN QUESTION:
(PAGE 2)
9)
AND
OF W
IS S
TWO
OF T
OF-W
· .,THE
OWN~
A)
B)
C)
NAMES OF ALL OWNERS ADJACENT, ACROSS THE ROAD OR HIGHWAY
?ACING THE PROPERTY AND ANY OWNERS ACROSS ANY RAILROAD RIGHT
~Y FROM SUCH PROPERTY. IN THE EVENT'THE PROPERTY AFFECTED
[TUATED AT OR WITHIN 100 FEET ON THE INTERSECTION OF ANY
)R MORE ROADS OR iHIGHWAYS, AT OR WITHIN ONE HUNDRED FEET
~ INTERSECTION OF ANY ROAD OR HIGHWAY WITH A RAILROAD RIGHT-
~Y OR AT OR WITHIN ONE HUNDRED FEET OF THE INTERSECTION OF
{IGHTS-OF-WAY OF ANY TWO RAILROADS, GIVE NAMES OF PROPERTY
tS AT ALL CORNERS OF ANY SUCH INTERSECTION.
[AILING ADDRESS: _, ~-~'11 1.0 ~_,'P-o~d . ,~4o,g~/ff~.
'AX MAP NO.:/I-/3SEC. NO.: SUBDIVISION NO :
.LOCK NO.: LOT OR PARCEL NO.: _~
ROPERTY OWNER'S NAME: ,~'7-
AX MAP NO.: /~-13 SEC. NO,: S~DIVISION NO.:
LOCK NO,: LOT OR PARCEL N.O.:
ROPERTY OWNER'S NAME: ~,13.~ ~' ~&'~-}-/)~t ,~"--~"~¢K
~AX MAP NO. :/~;,13 SEC. NO.: SUBDIVISION NO.:
BLOCK NO.: LOT OR PARCEL NO.: ,. ~ .........
T
B
PROPERTY OWNERtS NAME:
~ILING ADDRESS:
tX MAP NO.:
~DCK NO.:
SEC. NO.: SUBDIVISION' NO.:
LOT OR PARCEL NO.:
(P6GE 3)
E)
F)
G)
H)
I)
J)
PRO
MAIl
TAX
BLO(
PROt
MAII
TAX
BLO£
PROP
MAII
TAX
BLOC
PROP
MAIl
TAX
BLOC
PROP
MAIL
TAX
BLOC
PROP
MAIL
TAX
BLOC
ERTY OWNER'S NAME:
ING ADDRESS:
MAP NO.:
K NO.:
SEC. NO.: SUBDIVISION NO.:
LOT OR PARCEL NO.:
ERTY OWNER'S NAME:
ING ADDRESS:
MAP NO.:
K NO.:
SEC. NO.: SUBDIVISION NO.:
LOT OR PARCEL NO.:
ERTY OWNER'S NAME:
ING ADDRESS:
~AP NO.:
NO.:
SEC. NO.: SUBDIVISION NO.:
LOT OR PARCEL NO.:
ZRTY OWNER'S NAME:
£NG ADDRESS:
~AP NO.:
NO.:
SEC. NO.: SUBDIVISION NO.:
LOT OR PARCEL NO.:
RTY OWNER'S NAME:
[NG ADDRESS:
IAP NO.:
NO.:
SEC. NO.: SUBDIVISION NO.:
LOT OR PARCEL NO.:
RTY OWNER'S NAME:
NG ADDRESS:
~P NO.:
NO.:
SEC. NO.: SUBDIVISION NO.:
LOT OR PARCEL NO.:
(PAGE 4)
10 ) THE
($2
ADV
THI
TO:
I/W
AND
TRU
SUB
MY
APPLICANT HEREWITH DEPOSITS THE SUM OF TWENTY DOLLARS
.00) ATTACHED TO THIS APPLICATION, TO PAY THE COST OF
RTISING NOTICE OF THE HEARING OF SAID BOARD TO ACT ON
REQUEST. CHECK OR MONEY ORDER MUST BE MADE PAYABLE
TREASURER~ COUNTY OF CHESTERFIELD.
HEREBY DEPOSE AND SAY THAT ALL OF THE ABOVE STATEMENTS
THE STATEMENTS CONTAINED IN ANY EXHIBITS TRANSMITTED ARE
I NATO~/'O~F' ~^P PLI CANT
~Same name as used in item i-A,
page 1. )
~CRIBED AND SWORN TO BEFORE ME THIS. /~ DAY OF ~.~---- 19 ~7--
~/~ NOTARY
(PAGE 5)