3
The undersigned understands this application must be complete and accurate prior to
advertising a public hearing:
I am the owner of the subject property, or if corporation, I am the officer of the
corporation authorized to act on this request.
I am the legal representative of the owner of the subject property of this application.
(Notarized Authorization to Act must be submitted with application)
An approval of this application does not entitle the owner to a development permit.
I certify that the information in this application and all sketches and data attached to and
made part hereof are true and accurate to the best of my knowledge.
_________________________________________ _________________
Signature of Property Owner or Date
Authorized Representative
State of ___________________
County of ________________________
Subscribed and sworn to me before me this ______ day of, _________________, 20 ____,
personally appeared _______________________________, who is personally known to me or
produced _________________________ as identification, and who did / did not take an oath.
______________________________________
Notary Public Signature Seal