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Proposed water service: Ca+%_ public private (well) n/a Is this existing Y/N Proposed sanitary sewer: public private (septic) n/a Is this existing (YIN Hours of operation (if applicable): Day Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday By Appt. / 7 |e Fa Hours | ~ Peak hours: Number of employees (if applicable): Full-time 4/__ 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 ) RIA Wt Yoel Signature of Applicant/Petitioner Bobert Neti Ho p(s Print name of Applicant/Petitioner State of New York; County of Erie On the 5l ay ot imal in the year “@Z@ before me, the above individual appearéd, 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-fayposes therein stated. eet tty m, [re ee Oe, Vig Sh od ~ = STATE » Notary Public £ Sot to 4 = = FNOTARYPUBLIC: ert iT a 2 r s Qualified in :g 3 Erie County =F (Notary stamp) tO". = orviog4odze SS. sas “% a ie ve OS Sy Tle tag eet “ue SION EXP “ea Office Use Only: Date received: Receipt #: Application reviewed by: