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App 0fl <br />• FIDR - <br />MST0R1C PFM R'VA110N` COMMON <br />of S€ UTH SEND & S1". JOSEPH COUNTY <br />125 S. Lafayette DWI, South Berta, IN 46601 <br />httP:/AvwwstjosephcotmtyW1ana ur nt`deputmcntsWCHP/1 tdexhftn <br />P! 574-235=9798 A 574-"S-95-78 e: SBSJC cost;10 y�hJn. <br />,IIIA]] IIII 11 I 1 1 IIII 111111110111llllllllllll111111 IIII IIII IIIIII II. 111111111111111111 ilililymmillowl IIIIIIIAII Jill III III�I�IIIIIIIIII1I 1111111111111111111 111 11111111 I,IIIIIUI <br />WeRecill -51-ILl, AptrlltatlonNamur: <br />StaffAppri ral anthorlsed by: "Title. <br />AT— <br />Marie PrrxtrYatton Cemmtslaa 12ewivr t}at :. 1 r t� t .- <br />Law L.,IMM* Leat Historic Marte (mwil <br />h'atloaalIsrtdaeeark � iYai�:%stita�,ict�nrDicirl,�it ,. _ _ <br />CCtrrtltieat**fApt,.,w L/,6M3 <br />D nW Tnbted Stat -To CamimIttta Appxxrrrd and b:ael ; <br />Will 1 III 1 HillIIII1II III I IIIIIIII IIIIIIIIIIII IIIII I 1Ig111 I I Hill IIIIIIII IIII@ III IIIIIIIII I IIIIIIuII 11 IIIlII1l 1, I I I IIIIIIIII'llllMemo pfild) <br />11II1111u1u "I' 1 <br />}y e® <br />Addt t ofFtCt #fit tar 17t�Dp S wOitt: '7 1 d P). 5T <br />(Strret urrsbe Street Note=CRY.--Ap Mode} <br />Name of Ptvpftq owner(:): <br />Addren of Property Owner(s); <br />(SftdMmbrr-Street N -VpC ) <br />Name of Cantractor(:):� -� Pbonn <br />Contact Company Nantes <br />Address ofControct Cornpsur. <br />;(S"reet Number--�€t No"� VP Cane) <br />Citrtit Ute of13a[isiYng: �'`��� <br />(Singly �"cmrity--�LfcaltF Fu�rily-Ca►nmetct »�rxtriat--i✓c�nrrt--e Fc.�l <br />Type of Uullding Con ctlon: " "` +`• . <br />(Fp"ci' Frcurrew•-�rEcl�-,Slv�t---,Steer--C+�scr�tt�?lhr. r,� <br />Proposed "Waris: TU- rd Isndacapo 0 New F1Rep4cemtot (not1"r4 0 ntmolttioa <br />(mom than one bar may be cheekedi <br />t3 <br />Dtacripazt of Prc goacd4'oric; . h.c,. <br />dill <br />�. <br />c t x <br />O ner/ContractorFaaR: <br />(STgTw1t climwpond,wIthoniyonedest e) <br />. anchl <br />Mpatarre of 0woer Stgn;tturo of Coutrartor <br />t <br />