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THE CORPORATION OF THE CITY OF PORT COQUITLAH

"DEVELOPMENT PROCEDURES BYLAW, 1987, NO. 2243"
SCHEDULE "A"
Fnacted by Bylaw No. 2608

APPLICATION FOR
REZONING
OR
LAND-USE CONTRACT AMENDMENT/ CANCELLATION

SS ae epprren errant in ans TA AERC ee naa panearanmtrernparrrntmesninneine— ache Teena} pean rte aac sre crerveowne Se TN
TO BE COMPLETED BY APPLICANT ~ Please print clearly FILE NO.

ian

Applicant's Name Registered Owner

Address Address

Sane,
st eh

(include postal code) | (include postal code)

Phone Number . Phone Number

ee  cserneeenrerrrereannce

gern rae

Legal Description of Property

Street Address

Change Requested - (a) From Zone to Zone
(b) Other Change
Note: if subdivision is required please contact the Engineering Dept.

‘Present Use of Property

(Deseribe Buildings)

Proposed Use of the Property

(Describe New Construction Planned)

Size of Property

"seer gal narnneremsenaseti te Cet AA OO ace reece renee a cr seme ae
T/We declare that our interest in the property described above is as follows:

Initials

Registered Owner or Purchaser under Registered Agreement for Sale
Holder of a Registered Option to Purchase |

Holder of .
I am the agent of - who holds the
interest I have indicated above.

(Date) | | (Signature)

Non-refundable Fee

Fee for newspaper advertising and mailing
(refundable if Public Hearing is not held)

TOTAL FEE PAID

RECEIPT # DATE iTEM