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Property Owner Information <br />(Ifdifferent than Applicant) <br />Narne: <br />Same as above <br />Street Address: <br />City, State, ZIP: <br />Home Phone: <br />Work Phone: <br />Email: <br />Fax Number: <br />Please provide a detailed description of your request and attached a copy of <br />Please see attached <br />A "Land Use Sign" will be placed on the Subject Property to allow Ri <br />opportunity to obtain information about your requ <br />Applicant Signature <br />Co -Applicant Signature <br />Printed Name <br />jMatthew Chamberlain <br />Printed Name <br />Sar <br />Title jiVir. <br />Title <br />IV1i <br />Date <br />05/01/2020 <br />Date <br />05 <br />i understand that the application fee is non-refundable. All costs associated with the processing of tl <br />responsibility of the applicant whether this application is approved or denied. Any excess of escrow <br />exaenditures will be refunded at the time of account closure. I also understand that as the applicant <br />