........... EitsM eciaLt*c is-a -MO lOn••) Vt•)ACS1A riFFPRD atc:3 seS> -Jo P....PiAkY ,scriccm- Neff) "t-tit cciirXTION irtfle-.0 79 ENFece ME iG c<ET HIM Bc4cK IN 50-ioot Applicant's signature: Citi.,/0r7r/ Date: • Strike out whichever does not apply PART B: NOTICE OF HEARING