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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 /> 5-e.c A--lia-c44 <br /> • <br /> I certify that the above information is accurate to the best of my knowledge. I AM THE tidOwner [ J Authorized Agent <br /> Name(please print): /i141rA. My telephone number is: 5 b '510q' /r- <br /> Applicant Signature: y/�\ Date: 5130/Z07- <br /> Applicant's Mailing Address: ►J 5) {v r.►- I2 dk City: b i'''+ Zip: 47 7$S <br /> FOR OFFICE USE ONLY <br /> PLANNING: Date: <br /> PUBLIC WORKS: <br /> BUILDING INSPECTION(Acceptable for Planning requirements only) Date: <br /> A-330 Rev.05/2011,09/2012,2/4/2020 <br /> Page 4 of 5 <br />