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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 /> tACZS4)CL/j <br /> . . . . . . . . . . . .I . .\ . . 2 . . . . . . . <br /> • • • • "5eii.i.b) f • <br /> I certify that the above information• accurate to the best of my knowledge. I AM THE [ ] Owner [Authorized Agent <br /> Name(please print): GrejaLt �� My telephone number is: <br /> —IS'a— 9'66'U <br /> l <br /> ►� , <br /> Applicant Signature: / 1 Date: 1"'9"'1 q <br /> 1 <br /> 40 <br /> Applicant's Mailing Address: �7J5,C04.40(ci 11). _City: 54.104.l Zip: . 736 <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 />