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L'ajP.N RIVER COUNTY <br />PLANNED i)EVELOPI7 .ENT APPLICATION <br />Please lndicete tue tylie of applickdor. belrig aubict;teci: <br />Coneeptucl PD Special Exce„Lion: <br />Concurrent Conmyrtuul PG Specie.! Ercepton & 3'rzliral;stry PLT: <br />Preliminary Manna! De:elopment: <br />Final PI«nued Deveiopme it: <br />Note: For a PD rezoning p_;;ase use -ate rppropilaL rezoning cpplicatioa. <br />PROJECT NAME: <br />Plan Number: )'D- i { ;:;:' - L Z. <br />Project ##: s u:,c•t :E y t1 :;s? - <br />PROPERTY OWNER: (PLEASE PRINT) APPLICANT (PLEASE ?RINT) <br />NAME NAME <br />LA`C;+ 1).4��t�:tel (t,._ ,. t, . <br />ADDRir.SS <br />i4.... <br />-3466 <br />CITY, STATE, ZIP <br />45:1;1. CsIcl <br />PHONE NUMBER <br />r <br />t+tT.-1i,rtiC.�=,�►�t1C�.11 t (�% i*�s. <br />EMAIL ADDRESS' <br />h' e.t.r.>- c.37_ ",-t_E7. <br />CONTACT PERSON <br />PROJECT ENGINEER. (PLEASE PRINT) <br />AO Y.5 <br />NAME <br />ADDRESS <br />"1/4— <br />CITY, STATE, ZIP <br />5%L - - <br />PHONE NUMBER <br />t <br />r1UJ.DS�v� `u G.r C' :S <br />— an” Y <br />EMAIL ADDRESS <br />CONTACT PERSON <br />SIONA <br />F•\Community DcvdopmenetUsersiC urDeMppliwtions\PDAPP.doo <br />ADDRESS <br />CITY, STATE, ZIP <br />PHONE NUMBER <br />EMAIL ADDRESS <br />CONTACT PERSON <br />AGENT (PLEASE PRINT) <br />NAWX <br />ADDRESS <br />TY. STATE, 2IP <br />PHONE NUMBER <br />EMAIL ADDRESS <br />CONTACT PERSON <br />Oka <br />OF OWNER OR AGB <br />Revised Janury 7011 <br />ATTACHMENT j <br />P'ge 1of3 <br />55 <br />