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ditional Use Permit <br />Application <br />Applicant/Contact Information <br />-M2-/o <br />Applicant Name <br />O. Popis2 4Z-C- <br />Applicant <br />Address <br />Street address <br />7�/ Pai( i I� C. r AM_- <br />v <br />City <br />0 5 � o <br />State <br />�) <br />A) <br />Zip <br />-53 <br />Home Phone Number ( ) <br />Work Phone Number (74j) Aa 7 <br />— 3 c <br />Email Address <br />Fax Number ( ) <br />Name of Business (if applicable) <br />Business Address (if applicable) <br />Business Phone Number <br />Business Fax Number <br />Proposed site (subject property) of Conditional Use Permit <br />Address 6, 7 S 0 �A)/ ii AJ <br />ga nv( cey, /7/ A) -%-r-3 0 <br />PIN <br />6`{- 302 —(2-5- /3 —000 3 <br />Legal Description <br />ZO a, Po c/ l) <br />► ✓_air,s-, de 06 C` <br />(circle one) <br />Zoning R-1 / R-2 / R-3 / B-1 /400/ E-1 / E-2 / TC <br />other <br />Property Owner Contact Information <br />(if different from applicant's information) <br />Name <br />�" <br />®i doaii-v <br />Address <br />Street Address / <br />City <br />State <br />Zip <br />Phone <br />Number <br />Home phone number <br />( ) <br />Work phone number <br />(«0/a2 ) aya- <br />1 of 2 <br />Updated: January 2004 <br />