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SITE PLAN MUST SHOW ALL PROPERTY LINES AND DIMENSIONS <br /> ❑ Drawn to Scale: 1 square= Feet Not Drawn to Scale:Total Acres <br /> kee <br /> I certify that the above information is accurate to the best of my knowledge. I AM THE ,lpOwner [ ]Authorized Agent <br /> Name(please print): G w My telephone number is: CO3-501-51)S <br /> Applicant Signature- Date: 5/3 0/7 D Z 3 <br /> Applicant's Mailing Address: i3--73 fri i t itpL ,et/ City: $rh/7" Zip:1.7-. e_r- <br /> FOR OFFICE USE ONLY <br /> PLANNING: Date: <br /> PUBLIC WORKS: <br /> BUILDING INSPECTION (Acceptable for Planning requirements only) Date: <br /> A-33D Rev.05f2011,09/2012,2/4/2020 <br /> Page 4 of 5 <br />