Text · page 2 of 15
This document was a scan. Its text was produced by character recognition and may contain errors; check the original for exact wording.
V. SIGNATURES (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. 5 ) 1K NA UAO Choy o_ Signature of Applicant/Petitioner ori anne ( pros o_ Print name of Applicant/Petitioner State of New York; County of Erie On the26tday of L711 in the yearZO2@ 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, ame,,,,, for the plposes therein stated. on NE H Vigin, . | SSG STATE Sp [ Te OF NEW YORK”. % Notary Public = / NOTARYPUBLIC: 2 Se: Qualified in lod e%). Evie County 85 (Notary stamp) rae ZY. a Un SION EXPIRE os ROG Office Use Only: Date received: Receipt #: Application reviewed by: ECDP ZR-1 form sent to EC: Hearing publication date: PREVIOUS APPEAL(S): A previous appeal to the Zoning Board of Appeals ( ) has ( ) has not been made with respect to this property. Previous appeals: Date: Type of Appeal: Granted Denied Date: Type of Appeal: Granted Denied