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rOA CFrIC" US`s- CJIY V <br /> Conditional Permit No. Date 'IQ-,;ring :Idveraized _ <br /> Land Use Application No. <br /> Date Fee S D.:te <br /> Potice Posted Property O<mers Rlotified <br /> I <br /> APPLIC.ITION <br /> COMITY OF BURETT WIN= C011IT + + <br /> �i• (Ile) 5 � Jn r. ��K;r> > J of /3ox Sd-3„_ ��redE� < < W +'Sc, 5yr(3 7 <br /> r Name 1-Iailin3 Address <br /> hereby make application to the Zoning Committee for a conditional permit for the <br /> following: <br /> to Q O�yL< 'P0.041 f1�a; ��+ S�0. Sa,. a11� G(' wear �rOt\h cd t.y� <br /> N cr �-k S k or Q- 0 Y 1, �. <br /> on the following described property: <br /> Z a 4- (o 03 - C er'F 1,F,`e4 Ja r u e y t vl -p I U <br /> Location GUVe�,rn � � } LA+ -}-Wo a) QF <ec1 : �1� a� tyllU �w►�aQ /.5��]��- <br /> Lot Size _C1 U �,�� Present Use . Zoning; District <br /> Present improvements upon land <br /> Proposed Use C. <br /> List names and addresses of adjoining property otmers: <br /> Signature of +applicant Date <br /> Action taken by Zoning Committee <br /> Notes: <br /> Sig,ed <br />