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SITE PLAN FOR PROPOSED RESIDENTIAL DEVELOPMENT <br /> Site Address: r Lt Q v'€.v4a\e..__ Off- R 13©2 <br /> Township0 Y, Range 04 UJ Section 12 L Tax Lot 2_400 Total Acres Z.0 <br /> Subdivision Fc c S Block Lot 1 g <br /> ❑ Drawn to Scale: •❑ Not Drawn to Scale -OR- 1 square= feet <br /> 49-91 <br /> I certify that the above information is`` accurate to the best of my knowledge.I AM THE[ ]Owner or[ ]Authorized Agent: <br /> NAME(please print): L ,Otis C \ \C - o Telephone# n 1-21 t SCG <br /> Applicant's Signature: Date: 3/2.-k '1,0 i <br /> Applicant's Mailing Address: 5-GC,S S c X i►-A C ( - <br /> City: ‘"&=A0---� Zip: q 1 10(c Applicant's email: `tom `K—St 62 14,Ss LA <br /> S-31-1-2017 <br />