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Applicant Name <br />Major Plat Application <br />Sketch Plan <br />Applicant/Contact Information <br />/Pon /LIsr //r n 6 a <4 _rne — /N, , rl el-0 /4 <br />Applicant Street address City State Zip <br />Address oBfoQ /Ke•t6.. dye `1.1r1, *Jew /4k44 n/ 53-1,1/ <br />93-a - 98 s - 78,x'7 <br />Home Phone Number ( ) Work Phone Number ( ) <br />ysa-94(s--?'14°D <br />Email Address Faj ( ) <br />A//4 __\34. St. <br />Name of Business (if applicable) <br />Business Address (if applicable) % <br />4- kla) <br />Business Phone Number A 4 �� Business Faxtli ltir A1/4_ <br />Informa ' ni fining to ubj t Property(s) <br />Address N /A <br />PIN <br />Legal Description <br />kasoP r1N <br />�C1�C <br />Qi,7'LPT A, <br />(circle one) <br />Zoning R-1 / R-2 / R-3 / B-1 / B-2 / E-1 / E-2 / <br />Name <br />Address Street Address <br />Phone <br />Number <br />Town✓ CEN r-cie 2 N A AD ,O/7 70 i✓ <br />other <br />Property Owner Contact Information <br />(if different from applicant's information) <br />.5'nme As A-topcie.1,✓r <br />City <br />Home phone number Work phone number <br />State <br />Zip <br />1 of 2 <br />Updated: January 2004 <br />