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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 /> • <br /> I certify that the above information is accurate to the best of my knowledge. I AM THE [ ] Owner [ ]Authorized Agent <br /> Name(please print): My telephone number is: <br /> Applicant Signature: Date: <br /> Applicant's Mailing Address: City: Zip: <br /> FOR OFFICE USE ONLY • <br /> PLANNING: Date: <br /> PUBLIC WORKS: <br /> BUILDING INSPECTION(Acceptable for Planning requirements only) Date: <br /> A-33D Rev.05/2011,09/2012,2/4/2020 <br /> Page 4 of 6 <br />