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APRICATION FOR. LANDl
: ERM1:T, VARIANCE_ cax�;ZC}N1I
L-Ounty Pl�nni�.g C �ttMassi®a
F
File No, 1�.
I
y}. gate filed
-H 6ca �n go date
Action -6 Planning Commission
a
Action by Bo-zH of Supervisors
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1.7
PRESENT ZONING:
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>> REQUEST - . ,:
APPLIC`ANT'S NAME: -
P�:�7,VE:
ADDRESS- =
STATUS OF APPLICANT'S INTEREST IN PROPIRTX:
1
OWNER'S NAME:
PHONE:
ADDRESS:
DESCRIPTION OF PROPERTY: z
EXPLAIN! FULLY REASON FOR SPECIAL,. USE.
4
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The ,abore- statements are certified: by the undersigned. to be correct.,' -
Signature of Applicant
NOTE: Please submit herewith a check or money order in the amount, shown, below, payable to County detailed pint pian showing the location
eadjacent'
of existing and proposed structures on your property and on�the
Properties.
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Receipt i'`
No.