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7 Proposedwater service: Be - publi private (wet Me nla “ds thiss oxisting:6 YIN s Bs ~ Publ _ private (een). ve niet “ththis exiting: YIN ae ; : i ‘Proposed sanitary sewer, ee: ! sol : ‘Hours of operation (f applicable) me of Day” “Morday [Tuesday Weanesiay Sthasday Friday. | Saturday T Sunday : “By Appt: ie a : a oo Hours [Op en Gener Canrerenan Ceemmeenne, DMEM ES oe “Beak h hours: _ . ee ~ Number of. employees G applicable Failte. = eo ahaemieiemmbdeeltet -Partetime " Seasoril Upon approval of this apalcation, the1 applicant intends too apply for: (Chock all that tepe) : we - “a Building Pérmit: Jee oo, oo: , ee ~b. Sign Permit. | a 2 applicant/pettioner.. df ihe “Applicant is mot WV. SIGNATU RE. (This applicationmaust be.s signed by the: : _ he owner of the property, a. separate: owner authorization form. must Be submitted — ‘seeeR. 4 ty os a oo ; - Sigal of RoploantPationer - . : Jackson Guthrie 7 Se ee = oe a - > are ee : JOP ss cod + Print name of ApplicantiPettioner = ' - as ve ‘Staie of New York: County of: Ene . ee, the 6%ay ot Te inthe: year. Poof before me, the a ; Lo above individual appeayed, personally known:to-me on ‘the. Boe basis of satisfactory-evidence to be the individual ‘whose _. + Name is subscribed to, the: within instrumentand: | - Ce _ aaeknowledged tot cited: the: ‘same ae est nerein stated \ ge ete t re i eae ~ So EN el tary wblic: = State-of New. York | |S (Notary.stamp). 8 Jeno, OrsTaoassze, etree > ". Qualified. in:Wayne: Courity: at ” my Commission: Expires: Feb 6), 2039. een cet fchigepeneme OffUseicOnely: ‘Application -reviewed;by: