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CJRANGE COUNTY <br /> APPLICATION FOR ZONING PERMIT AND CERTIFICATE. OF OCCUPANCY* 1 3 t <br /> Zone ,Permit No. ,Board of Adjustment Case No.. <br /> Application is made to a structure .and/or premises <br /> (occupy, use, erect, alter, repair, remove, excavate) <br /> located at /—e - to be used for <br /> Agent: <br /> Owner: Builder: <br /> Address: t3a-i /69 / y Address: <br /> City: 24.:E/7 City: <br /> Estimated cost of work for which application is being made, <br /> A sketch of the proposed lot plan (plat) in duplicate shall be attached and <br /> made a part of this application. The sketch shall be drawn to a suitable <br /> scale and shall show accurate dimensions and location of each structure to <br /> be erected, installed, or altered. Front, rear, and side yard dimensions, <br /> and location of water and sewer facilities shall also be accurately shown. <br /> MAIN STRUCTURE INFORMATION <br /> Type of Use: Residential • Commercial Industrial <br /> Dimension of Lot Front Yard Dimensions: (d <br /> - <br /> Side Yard Dimensions Right: 3d Left: 6C� - <br /> Rear Yard Dimension: /40 -0° No. of Accessory Building: <br /> No. of Dwelling Units: <br /> ACCESSORY BUILDING INFORMATION <br /> Description (including use), O V% <br /> Setback from rear lot line Setback from..side lot line. tzr <br /> Dimensions a <br /> - x <br /> Zoning Permit Approved: Certificate of Occupancy Approved: <br /> P_`gyA 5( 19 76 19 <br /> Cote-41. Cesee..o.vt.4-4 <br /> irt <br /> Zoning Officer Zoning Officer _ <br />