HomeMy WebLinkAboutSP202000003 Ownership Documents 2020-01-22APPLICATION 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 1 own the subject property, or have the legal power to act on behalf of
the owner of the subject parcels) 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 Sigclass ni
���
natu e of N'ne / Agent / Contract Purchaser Date
Print Name Daytime phone number of Sig tory `J
Special Use Permit Application Revised 2/28/2019 Page 3 of 5
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany this zoning application if the application is not signed by the owner of the property.
1 certify that notice of the application for,
was provided to
of the application type & i(known the assigned application
[Name(s) of the record
the owner of record of Tax Map and Parcel Number �
by delivering a copy of the application in the manner identified below:
Oil
on
Hand delivery of a copy of the application to
Date
Mailing a copy of the application to
Date
to the following address
of the parcel]
[ ame of t e record owner if the record owner is a
person; if the owner of record is an entity, identify the
recipient of the record and the recipient's title or office
for that entity]
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the
recipient of the record and the recipient's title or office
for that entity]
[Address; written notice mailed to the owner at the last
known address of the owner as shown on the current
real estate tax assesspent books or current real estate
tssessment re rds satisfies this requirement].
-Signature of Applicant
Print Applicant Name
Date
Special i Ise Permit Application Revised 2/28/2019 Page 5 of 5