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Proposed water service: : public private (well) nia ts this existing YIN Proposed sanitary sewer: public _—_sprivate (septic) n/a Is this existing QIN Hours of operation (if applicable): Day Monday Tuesday | Wednesday _ Thursday — Friday Saturday | Sunday By Appt. Hours | (0am: Zpm|an- Lem |\an- lem | dyn Spon /0rp-lpm|(Oun- Zp \Z Peak hours: _/V IA Number of employees (if applicable): Full-time _ Part-time va L Seasonal Upon approval of this application, the applicant intends to apply for: (Check all that apply) a. Building Permit b. Sign Permit ws iV. SIGNATURE (This application must be signed by the applicant/petitioner._ If the applicant is not fhe owner of the property, a separate owner authorization form must be submitted — see pg. 4 ) S dignature of Applicant/Pétitioner — State of New York; County of Erie On the 3ddiay of dady in the yearROPL 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. NVvahiyd) | 6 Notary Publie~ | MICHAEL 0. SAMULSKI (Notary stamp) NOTARY PUBLIC, STATE OF NEW YORK ERIE COUNTY LIC. # 01SA6392645 COMM. EXP, 06/03/2027 Office Use Only: Date received: Receipt #: Application reviewed by: Laver)