Text · page 3 of 4
This document was a scan. Its text was produced by character recognition and may contain errors; check the original for exact wording.
Proposed water service: X public private (well) n/a Is this existing Y/N Proposed sanitary sewer: X public private (septic) _—s n/a_—siIs this existing X/N Hours of operation (if applicable): Day Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday By Appt. Hours | 9am-5pm| 8am-4pm_ | 8am-4pm 8am-4pm none none none Peak hours: above Number of employees (if applicable): Full-time 1% Part-time 0 Seasonal _ 0 Upon approval of this application, the applicant intends to apply for: (Check all that apply) a. Building Permit _X __ b. Sign Permit X 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) if Slgfature of Applicant/Petitioner Callie Wiliams, PCW Enterprises LLC Print name of Applicant/Petitioner State of New York; County of Erie On the fray of Januaryin the year 2026 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 purposes thgrein stated. (Notary stamp) Qualified in Erie County Conimission Expires Yr2O27 Office Use Only: Date received: Receipt #: Application reviewed by: