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SITE PLA�TIVIUST SHOW ALL PROPERTY LINES AND DIMENSIONS <br /> ❑ Drawn to Scale: 1 square= 5-C) Feet Not Drawn to Scale:Total Acres <br /> 13retiOGCe <br /> IL • A <br /> it‘ * * * * • • • • • <br /> -� , <br /> is P• <br /> s c•e. <br /> k <br /> I certify that the above information is accurate to the best of my knowledge. I AM THP; [> Owners[ I Authorized Agent <br /> Name(please print): f2 Gt v/ 5+ f-4/,J f\ My telephone number is: q I 1 1 a 5-9 3 67 6 <br /> Applicant Signature: p ) p �r/ ,1 Date: 3 I $ 1 1 <br /> Applicant's Mailing Address: l©q)D 5 IA fl7/i'1. "( io 5ICity: r n f r" Zip: (7 3??, <br /> FOR OFFICE USE ONLY <br /> PLANNING: Date: <br /> PUBLIC WORKS: <br /> BUILDING INSPECTION(Acceptable for Planning requirements only) Date: <br /> Page 4 of 5 <br /> A-33D <br /> Rev.05/2011,09/2012 • <br />