PB 24 06 PB Application

J. VERIFICATION AND AUTHORIZATION | SIGNATURE IS REQUIRED FOR ALL OF THE FOLLOWING: APPLICANT'S VERIFICATION I hereby certify that the above statements made by me and the information contained in the Papers submitted in connection with this application are true. I am aware that if any of the foregoing statements are willfully false, I am subject to punishment. Applicant's Signature: oe) pae:_/}az]a Yy oS 7 i CONTINUANCE Should the Planning Board/Zoning Board of Adjustment have a full and heavy agenda, or discussion and meeting regarding this application requiring carrying the matter past the statue time limit, the applicant grants permission for such an extension. Applicant’s Signature: wl Date: 1) a3) ay a OWNER’S AUTHORIZATION — MUST BE SIGNED Thereby certify that I reside at b Em mA A aA oo in the County of OC ¢ qin and the State of _jV@we Tense Y : and that I am the owner of all that certain lot, piece or parcel of land known as Block(s) _ ps 3 Lot(s) 26 Q on the Tax Map of Mest Onprwehich property is the subject of the above application, and that said application is hereby authorized by me. Furthermore, | authorize inspection of the site which is the subject of this application, Owner’s Signature: = = Date: Lf 2 3 QyU TAPLANNING.BRDWDocument Library\PR-2WA Application $-20-15.due