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Proposed water service: X public private (well) n/a ts this existing Y/N Proposed sanitary sewer: = —«X_— Ss public private (septic) n/a ts this existing X/N Hours of operation (if applicable): Day Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday By Appt. Hours | 9am-5pm| 8am-4pm_ | 8am-4pm 8am-4pm_| none none none Peak hours: _ above Number of employees (if applicable): Full-time 1 Part-time © | Seasonal _ 0 Upon approval of this application, the applicant intends to apply for: (Check all that apply) a. Building Permit _ X b. Sign Permit X 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) (fl Sighature of Applicant/Petitioner Callie Williams, PCW Enterprises LLC Print name of Applicant/Petitioner State of New York; County of Erie On the fray of Januaryin the year 2026 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 ee ¥, live. 2. Byler tary Public \ j | | \ ARSON L, BUSEORD (Notary stamp) Ree af jew York Conduission Expiigs WO] Office Use Only: Date received: Receipt #: Application reviewed by: