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Proposed water service: Ca+}%_ public private (well) n/a Isthis existing Y/N Proposed sanitary sewer: public private (septic) WA n/a Is this existing (YIN Hours of operation (if applicable): Day Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday By Appt. Hours vo. uv va Va Peak hours: Number of employees (if applicable): Full-time 47 __ Part-time Seasonal Upon approval of this application, the applicant intends to apply for: (Check all that apply) a. Building Permit b. Sign Permit IV. 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 ) Sse Yok Yo eh —— Signature of Applicant/Petitioner Reber t Neil He pM Print name of Applicant/Petitioner State of New York; County of Erie On the / 5 ay of Lpuiany in the year 7@2@ before me, the 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 acknowledged to me that he/she/they executed the same for the-farposes therein stated. either 1 Vin oe patente SP ot NE. Ca, Sie STATE ere %, Notary Public Os ORNEW YORE". % Fy F "NOTARY PUBLIC °:2 nnan ern) PUBLIC ; Qualified in z a (Notary stamp) ‘ ", O1VIO044Z9 Erie County =f & ry wee ee —— —— mm me mee ry a Office Use Only: _ Date received: Receipt #: Application reviewed by: