HomeMy WebLinkAboutSE202100034 Application 2021-07-26 (2)APPLICATION FOR A SPECIAL EXCEPTION
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.
I certify that notice of the application for,
was provided to
CARLKOCK
to reduce the required 125' setback for
lication type & if known the assign
owners
the owner of record of Tax Map and Parcel Number 05800-00-00-003J7
by delivering a copy of the application in the manner identified below:
Hand delivery of a copy of the application to
[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]
on
Date
XXX Mailing a copy of the application to BURMEISTER, CARL KOCK
[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]
on July 26, 2021 to the following address II `
Date
[ Address; written notice mailed tot the owner at the
last known address of the owner as shown on the
current real estate tax assessment books or current real
estate tax assessment records satisfies this
requirement].
Signature Signature of Applicant
Gregory Ailing
Print Applicant Name
July 26, 2021
Date
Revised 7/1/2021