Laserfiche WebLink
SPECIAL PERMIT APPLICATION <br /> COUNTY OF HAWAPI <br /> PLANNING COMMISSION <br /> (Type or legibly print the requested information) <br /> APPLICANT(S): Jo 4 rt A i*, XP,*! <br /> APPLICANT'S SIGNATURE: DATE: 2/3 /Z y <br /> ADDRESS: 73 - V05- IAC _ K 7 G <br /> LIST APPLICANT'S INTEREST (if not owner): i4 <br /> PHONE: (Bus.) (Res.) r6l- Y3o -o t t 3 (Email) Zft ar k l eV 414...5 LALW <br /> J..r+i'c..k.A+wn/clE�9,MrtJ/.c•* ..Cam <br /> REQUEST: We wov14 L-ke to 6r Aw.,rj AL 1,4 «J 6, ...k�tirt <br /> 0 . <br /> TAX MAP KEY: 3"7 "3 1 ZONING: — 3 A <br /> SIZE OF PROPERTY/AREA OF REQUESTED USE: 3 JA r re t <br /> LANDOWNER(S): ja4.. 44,'c t4 arlC .,,g Jw_ <br /> FEE SIMPLE LANDOWNER(S) WRITTEN AUTHORIZATION <br /> (may be provided by lettcrA,ith the below wteincrit included): <br /> DATE: 21312. <br /> CLk DATE: <br /> he above written authorization of the landowner(s gives permission for the applicant/petitioner to fil application/ <br /> petition an wledges that the landowner(s)and their successors are bound by the Special Permit is conditions. <br /> AGENT: <br /> AGENT ADDRESS: <br /> PHONE: (Bus.) (Res.) ail) <br /> Please indicate to Ti original correspondence and copies should be sen . <br /> ORIGINA COPIES: <br /> Planning Dept. <br /> Exhibit 1 <br />