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USE PERMIT APPLICATION <br /> COUNTY OF HAVVAVI <br /> PLANNING COMMISSION <br /> (Type or legibly print the requested information) <br /> APPLICANT(S): �CL1 CK. ,�/�06SON • � �� r 1�.�i��C �v � C4 f C <br /> APPLICANT'S SIGNATURE: '�=`� � DATE: <br /> ADDRESS: (S3 - S29 L)I,)A P _ -P06 S '' WA'l KOLt A <br /> LIST APPLICANT'S INTEREST (if not owner): <br /> PHONE: (Sus.) (Res.) (Email) <br /> REQUEST: <br /> TAX MAP KEY(S): � M g~002 5(0 ZONING: i—:5 9� <br /> SIZE OF PROPERTY/AREA OF REQUESTED USE: r_05 ACZE:S 1ll <br /> LANDOWI�iER(S): _ �f sG ,j A CCU LrJ�-met 6A <br /> FEE SIMPLE LANDOWNER(S) WRITTEN AUTHORIZATION <br /> (may be provided by letter with the below statenicnt included): <br /> DATE: <br /> +�c r 7f IUD U ACr ot� V5-1 OF DATE:__q <br /> AGENT: 1:1AC.t,g A it i V <br /> AGENTADDRESS: lbm6 <br /> PHONE: (Bus.) (Res.) (Email) C1f i5tCiC4=r =�` �u[r �:%t. <br /> Please indicate to whom original correspondence and copies should be sent. <br /> ORIGINAL: kN A 16b1xk 14„ 4emq►J _"u46A-- COPIES: _ F1u -i r.. _ Arn1A St�j <br />