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SITE <br /> <br />l~ope~y Ownen <br />Sit~ Afldre$$: _ <br /> <br />Lot:. <br /> <br />PI .AN FOR PROPOSED DEVELOPMENT IN MARION COUNTY <br /> <br />....... Subdivision: <br /> <br />Scale: <br /> <br />MC: 15- <br />Rev. 11~1 <br /> <br />Tax Account #: <br /> <br /> Drawn By: ~", ~-'~V~5-- <br />I certify that the above Bfo~_~afion is accurate to the best of my lmowledg¢. <br />Applicant (Please Print) .,,~.Sc~q ~.. ~ <br />Mailing Address: \\~ %~- ~Z~qS~ <br /> <br />A pplic an t's S ig~na_t~.re.~_~ ,_ <br /> FOR OFFICE USE ONLY <br />PLANNING: <br /> <br />PUBLIC WORKS: <br /> <br />BUILDING INSPECTION: <br /> <br />Dam: <br /> <br />Date: <br /> <br /> <br />