SITE NOTICE CERTIFICATION

• Application Number:

• Location
  Address

• I hereby certify that a site notice was placed on the public boundary of the above property in the location indicated below.

• Time and Date:

  Date

• How many signs are required?

  1

  2

  3

  4

  5

SIGN 1

• Location of sign
  Address

• Description of location of sign

• Photo of sign

  Media

• I hereby certify that a site notice was placed in the above location.

  Sign

SIGN 1

• Location of sign 1
  Address

• Description of location of sign 1

• Photo of sign

  Media

• Description

SIGN 2

• Location of sign 2
  Address

• Description of location of sign 2

• Photo of sign

  Media

• I hereby certify that a site notice was placed in the above locations

  Sign

SIGN 1

• Location of sign 1
  Address

• Description of location of sign 1

• Photo of sign

  Media

SIGN 2

• Location of sign 2
  Address

• Description of location of sign 2

• Photo of sign

  Media

SIGN 3

• Location of sign 3
  Address

• Description of location of sign 3

• Photo of sign

  Media

• I hereby certify that a site notice was placed in the above locations

  Sign

SIGN 1

• Location of sign 1
  Address

• Description of location of sign 1

• Photo of sign

  Media

SIGN 2

• Location of sign 2
  Address

• Description of location of sign 2

• Photo of sign

  Media

SIGN 3

• Location of sign 3
  Address

• Description of location of sign 3

• Photo of sign

  Media

SIGN 4

• Location of sign 4
  Address

• Description of location of sign 4

• Photo of sign

  Media

• I hereby certify that a site notice was placed in the above locations

  Sign

SIGN 1

• Location of sign 1
  Address

• Description of location of sign 1

• Photo of sign

  Media

SIGN 2

• Location of sign 2
  Address

• Description of location of sign 2

• Photo of sign

  Media

SIGN 3

• Location of sign 3
  Address

• Description of location of sign 3

• Photo of sign

  Media

SIGN 4

• Location of sign 4
  Address

• Description of location of sign 4

• Photo of sign

  Media

SIGN 5

• Location of sign 5
  Address

• Description of location of sign 5

• Photo of sign

  Media

• I hereby certify that a site notice was placed in the above locations

  Sign