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05/05/05 11:17 TEL 3J76241400
U
u
Charlier Clark &
DOCKET NO. O.sO 5 L;Q \ 1
TAC
DATE RECEIVED:
For l)etlattnJant US6 Only
Department of Community Services
TECHNICAL ADVISORY COMMITTEE
APPLICATION & PROCEDURES
Fee: $257.50
Property Infol7l1stion. ..a I . I'EI .. .... .. t t ... +. ... .......... II. g of II - . .. II .. ....... do. .... .. ..... . II II III a . a ... 11''' ........ ...... f ... . .. . I II .
ParceIID": /7 - / "3 - {J 7 - otJ - 22. - 003 J 060 Area (acres): I 9
Property Address; y- ,CJ~ M~ 11i~e.;I~/ P~rJ- IJd..~ a....a 'fer/'l. Sfl)8>p!
Zoning District I - I Overlay District (If applicable): A/lit
Legal Description: To be typewritten separately. f1 (( yfIDtAlT!'.i" Ptfl.r k 11;1';':-' e;k 8I()€..-~ "J
· Please attach a separate list for projects with multiple patC9/s. L ~(- S'
Attomey Infonnation" .. ..... 00.... .... ...'
Name: IV IA
Address:
Phone:
EmaiJ Address:
.. .
7671 Date
FIQI'II
CQ.
Pl'IOne II
Fad 5 .. 2/f 2.6
Fax .
Engineer Information.......... ......... ",
Name: Gi"""lj) r'? t?-11,"r.j
Address: /2 '( f L $4/ r f.c Dr, C ~r tnt..1 J I tV
,
Phone; C:. 77 - t) I Yo
Email Address: JSO'1"'!.fl,oJeearf4k.'l/c.It-.t.. f
...
'"' " 0 3 z.,.
Fax:
C)~nerln~r~ation ...a~t........D.D..f'."..........G.....~.....a.6..............~..m.aaaa.a..D.......,.,
Name: L/~n..... St' I u I- io'1S ) kG ,
Address: It! ~ I 50 u-lh Ckl .- k Dr, ...,,,
Phone Day: ~'7~ :..,~~&
Emsil Address:
ANn ~ &n j~ M,..... T fJe Join e if.
y
Evening:
"1DJ~l)~crilJtion..a.a....................D........."......~...a...a....D.D...D...~~.Q"..~..........,
Please include a briefsummarylhistory ofthB project e",., '3frvc It 0 h 0/ &.. 5rn,q IJ is 1'1l'.::~/
fJJ~tH.hu..'''-t:....; f't4.rk.':J 4/)d It'Jd.ch'r:; *r ~ /q",dsC~I'~ Cc".,fra.c.for. A
Sn1~" Sfar",~c- ()..ut:::$S,.r'f .s--J-rv<-";;~ u;/f 4/S0 bi?... C"ot)S~".Jr~ 0.... tJ.,e. .110/-(.
I, hereby sWBlilrthat I am the owner/contract purd'laser of propertyin\lOlved in this application and that the foregoing sigrlatlJres, statBments
and answers hel'Elin wntained and 1tle information herewith submitted are ill all respects true and correct to the be$t of my knowledge and
befief. I, the undersigned, authorize the applicantto act on mybehatfwitl'l regard to this application and subseQuent hearings and testimony.
10f3
S:\FORMS\PC Applications - culTtlnt\TAC only. doc
1/04105
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05/05/05 11:17 TEL 3176241400
U
Charlier Clark &
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Sl"...~ of Ow..., 14; ~ .
G ur s: Snell,,)
(P ted ame) .
A1G..,r ~r 24c~.... So lul.,-DhSJ Ltc-
Date:
2of3
S:\FORMSIPC Applications. currenl\TAC only.doc
1104105
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