HomeMy WebLinkAboutVariance - Waiver Request - Signed 010421subd.doc 5
09/22/05
VARIANCE/WAIVER REQUEST FORM
Date Filed C%'Y ZO
Plat Name 1>File No. S g s
Owner.-A61.0 61 p L L. Engineer: `",
Address: 1 4,,V o Address: ZY ►�a 1,� L,
Phone: SlD/- ZtZ _ yi q Phone: S,,01 $ - 6 '7
Variance(s) Requested:
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(2) ffi! M m
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Owner's Signature:-WU�IL OY' �C. �-�C.— Date 9 L%LD
PLANNINOMMISSION ACTION: �SB,arI�H
ApprovalWf Date ? " 3 `O Approval( ) Date
Imo() Date Denial () Date
JI"i&jWeeiaion. Basis for Decision: