HomeMy WebLinkAboutSP201900005 Ownership Documents 2019-06-04APPLICATION SIGNATURE PAGE
If the person signing the application is someone other than the owner of record, then a signed copy of the
"CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE
LANDOWNER" form must be provided in addition to the signing the application below. (page 5)
Owner/Applicant Must Read and Sign
By signing this application, I hereby certify that I own the subject property, or have the legal power to act on behalf of
the owner of the subject parcel(s) listed in County Records. I also certify that the information provided on this
application and accompanying information is accurate, true, and correct to the best of my knowledge. By signing this
application, I am consenting to written comments, letters and or notifications regarding this application being provided to me
or my designated contact via fax and or email. This consent does not preclude such written communication from also being
sent via first class mail.
Signature of Owne / Agent / Contract Purchaser
Print Name
S -a `�--Zo/`1
Date
33G. 34 S 6 y2 c,,
Daytime phone number of Signatory
Special Use Permit Application Revised 2/28/2019 Page 3 of 5