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S | eal Proposed water service: _© public ___ private (well) ___n/a Is this existing YIN Proposed sanitary sewer: __——_ public xX private (septic) __ n/a _Is this ex! isting ¥) N Hours of operation (if applicable): vay Monday | Tuesday “Wednesday Thursday Friday Satur day | St inday _| By Ap pte ~ | i Q - Qo “4 7 - qe + GF G mal _ Peak hours: _|()CL\Yvr} | Number of employees (if applicable): Full-time Part-time _ - Seasonal | apply) Upon approval of this application, the applicant intends to apply for: (Check all that a. Building Permit 7 b. Sign Permit \V. SIGNATURE (This application must be signed by the applicant/petitioner. if the applicant is not the owner of the property, a separate owner authorization form must be submitted — see pg. 4) C H S a s s y C a l o— NTA), O Si rate of Applicant/Petitioner Ao se y Colarero Print name of Applicant/Petitioner State of New York; County of Erie On theAnd day of Men 2’ 2before me, the the year above individual appeared, personally known to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and same acknowledged to me that he/she/they executed the we for Pepgerres therein ne H Use stajed- = RS S Teese Viggen, ‘hy \ Se 3 S'S CY 4 Ni Notary Public i: Guaitied :& S\. Erie County SG % (Notary stamp) cs ar we vy . * ; Office Use Only: Date received: SI Zk Receipt #: Tl 35 46 Application reviewed by: Lee