HomeMy WebLinkAboutApplication - REVISED 071625subd.doc 5
Ol/18/23
Plat Name er Ka
Owner: A
Address: /Z Z/ km
Phone:
�Ai�U-ANCE/WAIVER REQUEST FORM
Date Filed &(k
Jl File No.
L l Z Engineer: 'XQP.f e L
5 Address: z5 R ltiI cQ 1e,
72ZZ3 4 7
RUDD Phone: a D1 � ; l q— 14i
Variances) Requested:
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Justification:
A t3 en - 'n /
3wieris Signature: �Suq Date
PLANNING COMMISSION ACTION: BOARD OF DIRECTORS ACTION:
Approval ()Date
Denial ()Date
Basis for Decision:
Denial ()Date
Approval ()Date
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Basis for Decision: