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Proposed water service: C1 +4 __ public private (well) n/a Is this existing Y/N Proposed sanitary sewer: public private (septic) n/a Is this existing (YN Hours of operation (if applicable): Day Monday | Tuesday | Wednesday Thursday | Friday | Saturday | Sunday By Appt. Vv i/ a i” 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 ) BIA WA “Yo eM —— Signature of Applicant/Petitioner Robert Meili He plus Print name of Applicant/Petitioner State of New York; County of Erie On the (57 day ot Lignan 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 poses therein stated. SRN “ : / m, ny, f ceva Notary Public = ON ae . % > ! NOTARYPUBLIC . 3 A 3 = oe i ig 3 Notary stam he 5 RR ate OE (Notary P) Zo, OVvionded2? aid — oF vs “ly. “Apo%, 1“ aXy /teay Frat. O N EXP \ a SLT NTS Office Use Only: Date received: Receipt #: Application reviewed by: