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Email:
Subject:
Comment:
Label
Name:
Email:
Location:
Comment:
* = required field
*
Board/Commission:
Ballot Proposition Pool Committee No
Ballot Proposition Pool Committee Yes
Civil Service Commission
Code Enforcement Board
Historic Preservation Commission
Housing Authority
Parks and Recreation Advisory Council
Planning Commission
Public Facility District
Senior Services Advisory Committee
*
First Name:
*
Last Name:
*
Home Address:
Home Phone:
Business Address:
Business Phone:
*
High School Education:
College Education:
*
Length of Residence:
(in years)
*
Employment History:
Professional Memberships in Community:
Ethnic Origin:
African American
Asian
Caucasian
Hispanic
Native American
Other
Gender:
Female
Male
Disability:
No
Yes
* = required field
Project Information:
*
Project Name:
*
Project Type:
Annexation Agreement
Appeal
Binding Site Plan
Block Grant
Boundary Line Adjust
Comp Plan Amend
County
Env Impact Stmt
Final Plat
Hearing Examiner
Historical Preservat
Prelim Plat PUD
Preliminary Plat
Rezone
Sepa
Short Plat
Special Permt
Tax Parcel Segregati
Vacation
*
Project SubType:
Administration
Business License
CDBG
Church
Comm Dev
Comm Serv Facility
Commercial
Daycare Center
Economic Development
Finance
Homelessness
Housing
Industrial
Infrastructure
Low Income Projects
Other
Parks And Recreation
Public Facilities
Public Schools
Public Services
Public Works
Residential
Revitalization
*
Site Address:
Parcel Number:
Description:
Owner Information:
Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Cell:
Pager:
Other Name:
Email:
Applicant Information:
Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Cell:
Pager:
Other Name:
Email:
Developer Information:
Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Cell:
Pager:
Other Name:
Email:
Surveyor Information:
Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Cell:
Pager:
Other Name:
Email:
Architect/Engineer Information:
Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Cell:
Pager:
Other Name:
Email:
Resident Information:
Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Cell:
Pager:
Other Name:
Email:
Contractor Information:
Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Cell:
Pager:
Other Name:
Email:
Business Owner Information:
Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Cell:
Pager:
Other Name:
Email:
Contact Information:
Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Cell:
Pager:
Other Name:
Email:
Architect Information:
Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Cell:
Pager:
Other Name:
Email:
Site/Field Information:
Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
Cell:
Pager:
Other Name:
Email:
Enter Calendar Event:
*Event:
*Category:
Community
Meetings
Observed Holiday
Recreation
SpecialMeetings
*Description:
*Start Date:
( Format:
MM/DD/YYYY
Example:
01/23/2007
)
*End Date:
( Format:
MM/DD/YYYY
)
Recurrence Interval:
Weekly
Bi-Weekly
First Occurance in Month
Second Occurance in Month
Third Occurance in Month
Fourth Occurance in Month
Last Occurance in Month
First & Third Occurance in Month
Second & Fourth Occurance in Month
Event Day(s):
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
*Start Time:
( Format:
HH:MM
[
am
or
pm
]; Example:
03:45 pm
)
End Time:
( Format:
HH:MM
[
am
or
pm
] )
*Location:
*Contact Person:
*Contact Phone:
( Format:
XXX-XXX-XXXX
; Example:
212-232-3434
)
*Contact Email:
Additional Details:
First Name:
Last Name:
Email Addresss:
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