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Street Address of Property <br />Lef!al Description of Property <br />Owner's Name/7~.£, ~/~£&, ~~ <br /> Address ~/~0 <br /> <br />Applicant (if other than owner): <br /> Name ~A ~ ~~ ~. <br /> "~ress/~/~ ~~y ~, ~' -' <br /> <br />Type of Request: ( ) Variance -(~) Special Use Permit <br /> <br /> ( ) Review of decision (zoning administrator) <br /> <br />Description of Request ~ <br /> <br />CA R ['m~Af 7'~. y <br /> <br /> Date Ft led <br />H? y. lo <br /> <br /> Phone No. X~/- <br /> <br /> ( ) Rez( <br /> <br />· ( ) Oth( <br /> <br />'Reasons for Request <br /> <br />(Ordinance~6~--J /Section No. ) <br /> <br />Present Zoning Classification ~ Z) <br />Existing Use of the Property m/~_~Z~/~/~cg~'5 ~AA/O <br />Has a request for rezonin, g, variance, or special use permit on the property been <br />previousl.y sought? /~z/O If so, when? <br /> <br />Si.qnature of Applicant Date ~'- <br /> <br />Approved Denied <br />Approved Denied <br /> <br /> For OfFice Use Only <br /> <br /> by the Board of Appeals and Adjustments on <br />__.b.y the. Planning Commission on <br /> <br />, 19 , <br /> <br />Continued on Page 2 <br /> <br /> <br />