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Proposed water service: . public private (well) n/a Is this existing QIN Proposed sanitary sewer: public private (septic) so n/a ts this existing ON Hours of operation (if applicable): Day Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday | ByAppt. | Hours | Osu Zpm\Daac, Lom |MOae- Leen | (ban Lom| /tat-2pm|/Oamn- Zein VV | . mn Peak hours: als | Number of employees (if applicable): Full-time ss Part-time YL Seasonal Upon approval of this application, the applicant intends to apply for: (Check all that apply) a. Building Permit b. Sign Permit y 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 ) State of Naw York; County of Erie On theadbday of daly in the yearO2b 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 therein stated, MICHAEL D, SAMULSKI (Notary stamp) NOTARY PUBLIC, STATE OF NEWHORK E nE IBOUNTY # LI Saoegere Office Use Only: Date received: Receipt #: Application reviewed by: