20240892 Ver 1_Site Plan_20240701

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PROPERTY LEGAL
LOT NO. _
STRMT ADDRESS: ,
The undersigned,
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(Contractor / Agent)
to act on my behalf
this permit or certific
Property Owner's Aid
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PLAN NO. PARCEL Ida
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property owner of the above noted property, do hereby authorize
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(Nana of consulting firm)
take all actions necessary for the processing, issuance and acceptance of
n and any and all standard and special Conditions attxtied.
(if different than property above):
Telephone: It/ - I S? 2- - 2-vee5
information submitted in this applia t%n is true and accurate to the
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