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Of Lots: Street Access Name: Surface Type: Subdivision Name: Interior Street Names: Location of Nearest Water Line: (If Applicable) Received from application. payment in the amount of $ Check No. Cash to cover cost of processing this Receipt No. Date Paid I respectfully submit this application and certify that the above information is correct and true to the best of my knowledge. , 20 Date Applicant Signature , 20 Date Notary Public Fa y.
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Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
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