LAND USE +T p� I
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON laic 05 5Q/ kW^rcl b 't40 Mnt Cam�r'o>< 1 rrh 1c br%rr �k�er&o' 4vrn r gh 1' an Ho* ) irL (_.fps n.re�
(JS 341 ore rtn,c.d I1/0 - c nrcl- S), itgn Turn r90 on Toacc wo nri
If perm ts are granted I agree to conform to all ord nances and laws of the State of North Ca of na regulal ng s ch work and the specficat ons of plans submitted
I hereby state that for oing statements are accurate and correct to the best of my knowledge Permit subject to revocation if false information is provided
? hat Dr. �3Q „� 9-9- /7
Signature of Owner or Owner's Agent Date
It is the owner/applicants responsibility to provide the county with any applicable information about the subject property including but not limited
to boundary info matron house location ndergro nd o o e head easeme ts etc The co my or ts employees are not respons ble for y
incorrect or miss ng information that is contained within these appl cat ons
'This applicat on exp res 6 months from the initial date if perm ts ha e not been Issued
Residential Land Use Application Page 2 of 2 03/11