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O1/18/23
INFORMATION SHEET FOR
SUBDIVISION PUD's, PD's, ZONING
OR SUBDIVISION SITE PLAN REVIEWS
FILE NO. �j /'
NAME: el. o o e Cr
LOCATION:
DEVELOPER:
STREET ADDRESS
CITY/STATE/ZIP
TELEPHONE NO.
ENGINEER:
STREET ADDRESS
CITY/STATE/ZII'
TELEPHONE N(`1.
AREA 3. �� acmes
FT. NEW STREET yQD �
ZONING K ' Z
PLANNING DISTRICT
DATE (o 6 lso
Lci� wr -boo
VARIANCES REQUESTED
1.) seperate vort, tor-20)
3.)
4.)
NUMBER OF LOTS
�y
PROPOSED USES ��i'O l4T �' GCS
CENSUS TRACT
w
a►Jtr re y�,,fy� p.�
�.r► p rcoe M&4s
subd.doc 5
O1/18/23
Plat Name
Owner:.l
Address:
(3)
VARIANCE/WAIVER REQUEST FORM
tf sit Ow/
Justification: 1 w1
Date
1 File No
Enginef
Address
14 m"e 4w ignature: zy. W . Date
PLANNING COMMISSION ACTION:
Approval ()Date
Denial () Date
Basis for Decision:
BOARD OF DIRECTORS ACTION:
Approval ()Date
Denial () Date
Basis for Decision: