Text · page 2 of 2
This document was a scan. Its text was produced by character recognition and may contain errors; check the original for exact wording.
public _ private (well) __ n/a__Is this existing YIN
Proposed water service: _©__
Proposed sanitary sewer: __ public OS private (septic) ___ n/a_ Is this existing ¥/N
Hours of operation (if applicable):
Day | Monday] Tuesgay_| - Wesesday~ | Thursday [Frday [Satuday [Sunday
i
N [By Apo
_FIOUrS - eT — _ Gq | aa, IF
Peak hours: _ |()CLIY | -
Number of employees (if applicable): Full-time Part-time -'~ Seasonal
Upon approval of this application, the applicant intends to apply for: (Check all that apply)
a. Building Permit Y
b. Sign Permit C
\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)
ee
Vaso alow
ry , a /"
Conour oar
{\ /\
Signature of Applicant/Petitioner
Has ey Colareo
Print name of Applicant/Petitioner
State of New York: County of Erie
On theAntday of MA e071 the year 2’ 2before 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 pepefogses therein stated. CSSA?
5
\ fs oy
Notary Public
Guaiivied i :&
Si Evie County oy
(Notary stamp) %, Os, pr vioodoa2e rv
* * " ®
if . Sewanee? ®
Office Use Only: Date received: 5 | E Ly Receipt #: TI 454 C
Application reviewed by:
tod