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HomeMy WebLinkAbout70-04 Carnew One - Business Park - Back Creek - Backfile (2)SITE PLAN TRACKING SHEET Date: J� /c) q File opened Reference Manual updated/number assigned o D-base updated (� File given to Renee' to update Application Action Summary CLOSE OUT FILE: j 4a� oS-- Approval (or denial) letter mailed to applicant/copy made for file ( �4O.- File stamped "approved", "denied" or 'withdrawn" l 6 o Reference Manual updated �(o D-base updated File given to Renee' for final update to Application Action Summary U1Cmi\Common\Tacking ch�-a\3iie Plan Tm-ling.wO P,cvis:E 02107l07 SITE PLAN APPLICATION CHECKLIST The checklist shown below specifies the information which is required to be submitted as part of the site plan application. The Department of Planning & Development will review the application to ensure that it is complete prior to accepting it. If any portion of the application is not complete, it will be returned to the applicant(s). (1) One (1) set of approved comment sheets are required from each relevant review agency prior to final approval of a site plan. It is recommended that applicants contact the Department of Planning & Development to determine which review agencies are relevant to their site plan application_ A list of potentially relevant review agencies is shown below: Frederick County Department of Planning & Development Department of GIS (Geographic Information Services) Frederick County Sanitation Authority ✓ Frederick County Building Inspections Department Frederick County Department of Public Works Frederick County Fire Marshal X Frederick County Health Department X Frederick County Department of Parks & Recreation k_ Virginia Department of Transportation (VDOT) _, City of Winchester y. Town of Stephens City yA Town of Middletown Frederick County / Winchester Airport Authority t/ (2) One (1) copy of the Site Plan application form. (3) Payment of the site plan review fee. `� (4) One (1) reproducible copy of the Site Plan (if required). a m 0 m m 0 f Q 0 DATE NO. 5045 all ACCOUNT GASH _ AMT PAID �; CHECK BALANCE MONEYS BY fr,f ORDER � A I ( COUNF Y of P CK Department of Planning and Development 540/665-5651 FAX: 540/ 665-6395 January 26, 2005 Mr. Gary Oates GreyWolfe, Inc. 1073 Redland Road Winchester, Virginia 22603 Re: Approval of Site Plan 470-04; Carnew One, LLC Property Identification Number 75-3-18 Dear Gary: The above -referenced site plan was approved on January 25, 2005. The site plan is approved for the construction of a new general office building and computer back-up building located on Sulky Drive. The general office building consists of 8,050 square feet and the computer back-up building consists of 600 square feet. Required site improvements include the following: Construction of a parking lot with 35 spaces (including two handicap accessible), including curb and gutter, a sidewalk, landscaping, striping, and handicap access. Construction of a dumpster pad with a six (6) foot wooden fence for screening. One 12' x 45' loading space. I am providing you with four (4) copies of the approved site plan. Please forward these copies to the appropriate representative(s). Furthermore, advise the owner(s) that a copy should be kept for future reference, and an approved copy must be kept on the construction site throughout the development process. Once site development is complete, the owner(s) should contact this office to schedule an on -site inspection. Do not hesitate to contact me if you have any questions or concerns. Sincerely, Candice E. Perkins Planner II CEP/bad cc: Jane Anderson, Real Estate Patrick Barker, Economic Development Commission Gene Fisher, Shawnee District Supervisor William Rosenberry, Robert Morris, Shawnee District Plamling Commissioner Ralph Gregory, P.O. Box 520, Stephens City, VA 22655 Carnew One, LLC, 212 Little Pond Lane, Winchester, VA 22603 107 North Kent Street, Suite 202 • Winchester, Virginia 22601-5000 • 0 TRANSMITTAL LETTER JAN 1 0 20U) L. - -------- ,��.,ut1iJTY PLPi'�JEL �!r f.)E1'Uf'i,4Ffd1' GREYWOLFE, INC. I� A 07 1073 REDBUD ROAD • WINCHESTER, VA 22603 _-- ��!� (540) 545-7823 • (540) 545-4001 FAX A� �.j GREYWOLFEINC@AOL.COM 1�1 'r Frederick County Planning & Development January 17, 2005 107 North Kent Street Winchester, VA 22603 Attn: Candice Perkins Subject: Carnew One, LLC Site Plan, 2"d Submission Dear Madam: Attached is a revised copy of the Carnew One site plan originally submitted in December and all approval letters from review agencies. Upon receiving comments from your department, the plans have been revised. Z." The magisterial district has been changed to Shawnee on all sheets. _2. The CG-2 curbing on the lighting detail has been changed to CG-6. 3. The hedge plantings are noted to be 3 gallons in size and the trees at 2" caliper minimum. -4. All improvements requested by the fire marshal are shown. Utility easements. Currently there are not any utilities other than sewer and water on this street. I have shown the preferred location of the electric, telephone, and gas lines at the rear of the building. The final placement of these lines will be determined by the respective utility companies when they are installed. A note on the cover sheet states that they must be underground. ,:6' The computer room is a building housing a large back-up computer for this business. There are not any offices, bathrooms, or any intent to have anyone in the room other than technicians for periodic inspections. 7. The pavement area behind the office is not a designated loading area for deliveries. The owners of this business wanted access to a larger door. An increase to 12' can not be accomplished due to the 5' setback from the property line. • Thank you, C Gary �. Oates, LS-B, EIT GreyWolfe, Inc 0 1,q 0 • Request For Site Plan Comments Frederick County Inspections Department Mail to: Frederick County Inspections Dept. Attn: Building Official 107 North Kent Street Winchester, VA 22601 (540) 665-5650 Hand deliver to: 107 N. Kent Street Fourth Floor Winchester, VA (540) 665-5650 RECEIVED FREUERICK COM S:AUC WORN & INSPECTIONS Please fill out the information as accurately as possible in order to assist the agency with their review. Please attach one (1) copy of the site plan with this sheet. Applicant's Name Address: Phone Number: GreyWolfe, Inc. 1073 Redbud Road Winchester, VA 22603 (540) 545-7823 (Contact: Gary Oates) Name of development and/or description of the request: Carnew One Location of property: Sulky Drive, Battlefield Partnership Development Park Inspections Department's Comments: (B m m PNl �_5 4 r rt? 6 h czi _L-- Milt 4 orm _ De ons ecti insppeCil Y` use onlyiG�$EydYU'4R. laic rmcivcd Date revisioa nxcivcd �- --- Dett approved Le rcvicww _ Doc Mi , ill,vii ;signature and hate _ .:_. - —' _ Sig aturc aM Datc (rcvisicsu} RE. 17 0 0 • Buildings shall comply with The Virginia Uniform Statewide Building Code and section, 304, use group B (Business), of the International Building Code/2000. Other Code that applies is IBC/ANSI Al 17.1-98 Accessible and Usable Buildings and Facilities. HC parking spaces and unloading shall not slope greater than 2% across area . Please confirm slopes are in compliance on the accessible route from the parking to the structure. All required egress doors shall be accessible to a min. exterior area for assisted rescue, section 1003.2.13.7.IBC . Note Fire rating requirements around the door if this section is utilized. Note : Table 602 of IBC for the Fire Rating requirement in reference to the property line depending on type of construction used. Sewer Clean outs shall be located within 5' of the building wall This type structure shall be subject to special inspections according to chapter 17 of the IBC., (soils, concrete, etc.). Request For Site Plan Comments Frederick County Sanitation Authority Mail to: Hand deliver to: Frederick County Sanitation Authority 315 Tasker Road Attn: Engineer Director Stephens City, VA P.O. Box 1877 (540) 868-1061 Winchester, VA 22604 (540) 868-1061 DEC 2rs4 I '14 t Please fill out the information as accurately as possible in order to assist the agency with their review. Please attach two (2) copies of the site plan with this sheet. Applicant's Name: GreyWolfe, Inc. Address: 1073 Redbud Road Winchester, VA 22603 Phone Number. (540) 545-7823 (Contact: Gary Oates) Name of development and/or description of the request: Carnew One Location of property: Lot 18, Sulky Drive, Battlefield Partnership Development Park Frederick County Sanitation Authority's Comments: Sanitation Authority use only Date received _ Data reviskm received Tate approved i inccnnpleit Inccxrt}�it�e �� Date reviewed lDW rcVCWt4 I. Si"Um and Date `Signature am mate (revision)_ > '144 Request For Site Plan Comments Frederick County Engineering Department Mail to: Frederick County Engineering Dept. Attn: Director of Engineering 107 North Kent Street Winchester, VA 22601 (540) 665-5643 Hand deliver to: 107 N. Kent Street Fourth Floor Winchester, VA (540) 665-5643 Please fill out the information as accurately as possible in order to assist the agency with their review. Please attach two (2) copies of the site plan with this sheet. Applicant's Name:. GreyWolfe, Inc Address:. 1073 Redbud Road Winchester VA 22603 Phone Number: (540) 545-7823 (contact: Gary Oates) Name of development and/or description of the request: 18 Carnew One 0 FR Request for Site Plan Comments Virginia Department of Transportation Mail to: Virginia Department of. Transportation Attn: Resident Engineer 14031 Old Valley Pike Edinburg, Virginia 22824 (540) 984-5600 Hand deliver to: Virginia Department of Transportation 1550 Commerce Street Winchester, VA (540) 722-3460 Please fill out the information as accurately as possible in order to assist the Virginia Department of Transportation with their review. Please attach five (5) copies of the site plan with traffic generation data and drainage calculations with this sheet. Applicant's Name: GreyWolfe, Inc. Address: 1073 Redbud Road Winchester VA 22603 Phone Number: (540) 545-7823 (Contact: Gary Oates) Name of development and/or description of the request: Carnew One Location of property: Sulky Drive, Battlefield Partnership.Development Park, Lot 18 in Frederick County, VA Virginia Department of Transportation's Comments: A VDOT review indicates it appears everything has been designed to meet our minimum requirements. As you know, Sulky Drive is i jut ii i d je Sucoi idai y Systei j date. ftembr, d land usu VOMit 011 not be MqUited unia-z Sulky Dive is added to die System pdpr t j rnnrtniCtinn of thr entranra PlPaw notes M;;mfhnn Drives iG artually Pnt1tP 1 nq1 R Urclonty J. COUNTY ---PLAT-'�,I''.`�.'�_�:�F`✓EI_GPJVIENT n n U a' to: Winchester Regional Airport Attn: Executive Director 491 Airport Road Winchester, VA 22602 (540) 869-2422 Request For Site Plan Comments Winchester Regional Alrport Hand deliver to: 491 Airport Road (Route 645, off of Route 522 South) (540) 869-2422 Please fill out the information as accurately as possible in order to assist the agency with their review. Please attach one (1) copy of the site plan with this sheet. Applicant's Name: GreyWolfe, Inc. Address: 1073 Redbud Road Winchester VA 22603 Phone Number: 545-7823 Fax 545-4001 Name of development and/or description of the request: Carnew One Planning to build office space Location of property: Lot 18, Sulky Drive, Battlefield Partnership Development Park Winchester Regional Airpprt Comments: 'J-e P 0-An -kP ck _ P Ac - 25 JAN U L V FRFDF ilGK COUNTY- & DEVELOPMENT r� r� u .'�Ak SEMNG THE TOP Of VLRG6UA / WINCHESTER REGIONAL AIRPORT December 8, 2004 GreyWolfe, Incorporated 1073 Redbud Road Winchester, Virginia 22603 491 AIRPORT ROAD WINCHESTER, VIRGINIA 22602 (540) 662-2422 Re: Site Plan Comments Bean Suites, Lot 18, Carnew One, LLC Kernstown Business Park Back Creek Magisterial District Dear Sir/Madam: After review of the referenced Site Plan it appears that this proposal should not have a negative impact on operations of the Winchester Regional Airport therefore special conditions will not be required, Thank you for the opportunity to review these plans. Sincerely, 6fd�am. Serena R. Manuel Executive Director JAIN 8 200 FR'-TFF,ICK COUNTY e, DEVELOPR IIENITT • • Request For Site Plan Comments Frederick County Fire Marshal Mail to: Hand deliver to: Frederick County Fire Marshal 107 N. Kent Street Attn: Director of Engineering First Floor 107 North Kent Street Winchester, VA Winchester, VA 22601 (540) 665-6350 (540) 665-63W Please fill out the information as accurately as possible in order to assist the agency with their review. Please attach two (2) copies of the site plan with this sheet. Applicant's Name: GreyWolfe, Inc. Address: 1073 Redbud Road Winchester, VA 22603 Phone Number: (540) 545-7823 (Contact: Gary Oates) Name of development and/or description of the request: Carnew One Location of property: Lot 18, Sulky Drive, Battlefield Partnership Development Park Fire Marshal's: Request For Site Plan Comments 19 0 0 J A N 1 00 2005 FREDERICK COUNTY PLANNIN"G & DEVELOPMENT Ak . �e 'VIRGININ, Control number SP04-0071 Project Name CarnewOne Address 1073 Redbud Road Type Application Site Plan Current Zoning B2 Automatic Sprinkler System Yes Other recommendation Emergency Vehicle Access Adequate Siamese Location Not Identified Emergency Vehicle Access Comments Access Comments Additional Comments Plan Approval Recommended Yes 0 Frederick County Fire and Rescue Department Office of the Fire Marshal Plan Review and Comments Date received Date reviewed Date Revised 12/7/2004 12/9/2004 Applicant GreyWolfe Inc. City State Zip Applicant Phone Winchester VA 22603 540-545-7823 Tax ID Number Fire District Rescue District 75-3-18 11 11 Recommendations Automatic Fire Alarm System Yes Hydrant Location Adequate Roadway/Aisleway Width Adequate Reviewed By Timothy L. Welsh Election District Back Creek Residential Sprinkler System No Fire Lane Required Yes Special Hazards No Signature 0- Title 1 0 0 !r� fA, J AN 1 8 20]50- D FRE_ [RICK COUNTY PLAWNG & DEVELOPMENT l� FREDLRICK COUNTY Request For Site Plan Comments P1 inn+^,:; n ✓`-1Ca��ENT Frederick County Engineering Department — Mail to: Frederick County Engineering Dept. Attn: Director of Engineering 107 North Kent Street Winchester, VA 22601 (540) 665-5643 Hand deliver to: 107 N Kent Street Fourth Floor Winchester, VA (540) 665-%43 Please fill out the information as accurately as possible in order to assist the agency with their review. Please attach two (2) copies of the site plan with this sheet. Applicant's Name: Address: GreyWolfe, Inc 1073 Redbud Road Winchester. VA 22603 Phone Number, (540) 545-7823 (contact: Gary Oates) Name of development and/or description of the request: Carnew One Engineering Dept. use only Date received IjK�otnpiete Dow reviewedt9��y Signature and Date Signauffe and Date (revision)_ Date revision received Incompkfe rite reviewed Y 18 Date approved COU COU of FREDERICK W r Department of Planning and Development a, 540/665-5651 FAX: 540/665-6395 December 20, 2004 Mr. Gary Oates GreyWolfe, Inc. 1073 Redland Road Winchester, Virginia 22603 Re: Review Comments for Site Plan #70-04; Carnew One, LLC Property Identification Number 75-3-18 Dear Gary: ve approval can Planning Staff has reviewed the above -referenced site of plan da' granted, �re if This asiterplan islden denied until the be granted. At this time, administrative approval cannot gd. ther review age ately addresse issues in this letter, as well as all issues of the oeae have r revised siteplan which adequately Please review Staffs comments listed below and then prepay addresses each concern. Review Comments: 1) Magisterial District. The Magisterial District for this property is Shawnee, not Back Creek. 2) Standard Curb.. The detail for the light poles shows 6a CG-2 curb. the Zoning Ordinance requires that all curb around parking areas must be C 3) Landscaping, Plan. Under the proposed plantings, please include that the hedge plantings must be at least a tl-ffee gallon container and the tree plantings must be at least a two inch caliper at the time of planting. 4 Fire Code Improvements. Please show the location of all improvements required by the Frederick County Fire Marshal. 5 Utility Easements. The water and sewer locations areshown; howeverof all utililt es locaas tions as any of the other utilities have not been shown. Please show the locations required easements. 6 Computer Room. Please provide further clarification on what this "computer room" will be used for. 107 North Kent Street, Suite 202 • Winchester, Virginia 22601-5000 0 • Mr. Gary Oates Re: Carnew One, LLC December 20, 2004 Page 2 7) Pavement Area Behind Office. There is an eight foot wide pavement area behind the office building. If this area is intended to be used for any deliveries, the pavement must be at least 12' wide. After you have revised the site plan, please resubmit one copy so that I may verify the information contained on the plan. I will need all approved review agency comment sheets and at least five copies of the final plan for approval. Comment sheets are required from the following agencies: the Virginia Depcirtinenl of Transportation, the Frederick County 1»spections Deparinnent, the Frederick County Engineer, the Frederick County Fire klarshal and the Frederick CoL1171)) Sanitation Authority. Do not hesitate to contact me if you have any questions or concerns regarding this letter. Sincerely, Candice E. Perkins Plamier II CEP/bad cc Ralph Gregory, P.O. Box 520, Stephens City, VA 22655 T T -, l ') T :4,t� n—ri T nrip winrhesier_ VA 22603 Site Plan Information Checklist The following information must be included on your site plan. If your site plan is incomplete or is missing information, it will not be reviewed and returned to you for revisions. Administrative Information Y N 1. Name of proposed development. ✓ 2. Name, address, and phone number of owner. 3. Name, address, and phone number of developer. 4. Name, address, and phone number of designer. 5. Certificate of surveyor, engineer, or architect. 6. Date plan prepared and date of revisions. 7. A listing of all conditions placed on the site as a result of a conditional use permit or conditional zoning approval. 8. A space labeled "Approved by the Zoning Administrator" for the approval signature and date of approval. Jl r� 9. A description of setbacks or conditions placed on the site as a result of a variance approval. (Reference the variance application number.) General Site Information Y N ✓ 10. Location map (scale 1:2000) t✓ 11. Magisterial District- J*)aw 12. Scale of site plan (not to exceed 1:50) 13. North Arrow 14. Zoning of site 15. Use, zoning, and Property Identification Number (PIN#) of all adjoining properties. This includes properties located across right- 01 of -ways, streams, and railroad tracks. ✓ 16. Surveyed boundaries for all lots and parcels. General Site (con't) Y N 17. Acreage of all lots included in the plan. ✓ 18. The location and dimensions of all required setbacks and yard areas. Nl �- 19. The location and type of all dwelling units. N N 20. Location and description of all recreation facilities. 21. Location of sidewalks and pedestrian ways. 22. Location and area of common open space. 23. The location, height, and dimensions of all signs. 24. Location, height, and specifications of outdoor lighting fixtures. 25. Location and nature of outdoor storage areas. 26. Location of outdoor trash receptacles and dimensions of structure (fencing, etc.) required to enclose receptacles. Building Information Y N 27. The height of all buildings and structures. ✓ 28. Location of all buildings, structures and uses. 29. The proposed use of each building, structure and area. ✓ 30, Ground floor area and total floor area of all buildings with FAR calculations for commercial and industrial zoning districts. Roads Y N 31. Name and number of existing and planned streets on and adjoining the site. �✓ , 32. Location of existing and planned streets on and adjoining the site. ✓ 33. Posted speed limit of existing adjacent roads. �✓ 34. Location and dimensions of all proposed entrances from public right-of-ways. m 35. Location of all entrances on adjoining roads within 200 feet of the proposed or existing entrance. 36. Dimensions, boundaries, width, pavement, and construction of planned roads. Utilities Y N 37. Location of all utilities, including sewer and water lines with the size of lines, mains, and laterals. 38. Location and width of all easements, including access, utility, and drainage easements. - sr, ��'i,l`h-e 1� s 39. Location and nature of fire lanes, fire hydrants, and all other facilities necessary to meet Fire Code requirements. Parking Y N 40. Calculations describing the required number of parking and loading spaces. 41. Location and dimensions of all parking and loading spaces, driveways, parking aisles, curbing and other features to be used. 42. Location and dimension of all disabled parking spaces and ramps. 602_1,0 �a K-P Natural Features Y N 43. Existing and finished contour lines. 44. Location of steep slopes, woodlands, floodplains, wetlands, sinkholes, and other environmental features. N ( 45. Location of streams and drainage ways. Landscapinq Y N 46. Landscaping plan describing location and types of plants to be used. 47. Location of required buffers and screening with cross sections or profiles. Erosion and Sediment Control Y N 48. A stormwater management plan with run off calculations and location and description of facilities to be used. 49. Soil erosion and sedimentation control plan describing the location and methods to be used to minimize erosion and sedimentation during development. 12 • 11 SITE PLAN APPLICATION Department of Planning and Development Use only. Date application received Application # - Complete. Date of acceptance 4 Incomplete. Date of return. Carnew One 1. Project Title 2. Location of Property Sulky Drive (street address) Winchester, VA 22603 3. Property Owner. Ralph S. Gregory Address: PO Box 520 _ Stephens City, VA 22655 Telephone: (540) 869-3500 4. ApplicantlAgent GreyWolfe, Inc. Address 1073 Redbud Road Winchester, VA 22603 Telephone: (540) 545-7823 Contact: Gary Oates Same 5. Designer Address: ,Contact: Telephone- A FREDERICK PLANNING COUNTY & DEVELOPMENT 6 • • [.1 7a 7b 8 a) b) c) d) e) fl g) Is this an original or revised site plan? Total acreage of parcel to be developed: Total acreage of parcel. Property Information: Property Identification Number Current Zoning: Present Use: Proposed Use: Adjoining Property Use(s) Adjoining Property Identification Number(s) Magisterial District(s) Original X Revised 0.8 acres 0.804 acres 75-(3)-18 B-2 Vacant General Office Business Park, Interstate 81 75-(3)- 17 & 30 Back Creek District I have read the material included in this package and understand what is required by the _ Frederick County Planning Department. I also understand that all required material will be complete prior to the submission of my site plan. Signature: �( Date: I FREDERICK COUNTY NINING & DEVELuPN1 7 Special Limited Power of Attorney County of Frederick, 'Virginia Planning Office, County of Frederick, Virg i, 167 North Kent Street, Winchester, Virginia 222601 Phone 54"65-WI Faermile 540-6f5-6345 Know All Men By These Presents_ That I (We) (Name) Ralph S. Gregory (Phone) 869-3500 (Address) P.O. Box 520 Stephens City, VA 22655 the owncr(s) of all those tracts or parcels of land ("Property") conveyed to me (us), by deed recorded in the Cleric's Office of the Circuit Court of the County of Frederick, Virginia, by Instrument No. 913 on Page 1429 and is described as Parcel: 75 Lot: Block: Section: 3 do hereby make, constitute and appoint: (Alarm) GreyWolfe, Inc. Subdivision: 18 (pie) (540) 545-7823 (Address) 1073 Redbud Road, Winchester, VA 22603 To act as my true and lawful attorney -in -fact for and in my (our) name, place and stead with full power and authority I (we) would have if acting personally to file planning applications for my (our) above described Property, including: ❑ Rezoning (Incladiag proffers) ❑ Conditional Use Permits ❑ Master Development Plan (Preliminary a»d Final) ❑ Sabdivisi" of Site Plan My attomcy-in-fact shall have the authority to offer proffered conditions and to make amcrAmcnts to previously approved proffered conditions except as follows: This authorization shall expire one year from the day it is signed, or until it is otherwise rescinded or modified_ G In witness thereof, I (�jre) havc�bcrcto set my (our hand and seal this day of / l State of Virginia, City/County of �G�CL�•�/l%/� , To -wit: 1,jl �" / a Notary Public in and for the jurisdiction aforesaid, certify that the person(s) who signed to the fo ing instrument and who is (are) known to me, personally app 1 befo5c me and has acknowledged the same before me in the jurisdiction aforesaid this of of v 2� My Coriunissieri Expires: Notary Public • • Request For Site Plan Comments Department of Planning and Development Mail to: Hand deliver to: Department of Planning and Development 107 N. Kent Street Attn: County Planner Fourth Floor 107 North Kent Street Winchester, VA Winchester, VA 22601 (540) 665-5651 (540) 665-5651 Please fill out the information as accurately as possible in order to assist the agency with their review. Please attach two (2) copies of the site plan with this sheet. Applicant's Name Address: Phone Number: GreyWolfe, Inc 1073 Redbud Road Winchester, VA 22603 (540) 545-7823 (contact: Ga Name of development and/or description of the request: Location of property: Oates) Carnew One, LLC Sulky Drive, Battlefield Partnership Development Park Planning and Development's Comments: Planning and Development use only Date rec6vod lncC)MPjC e Date rcvkwad Signature and Date Signature and Date (revisi ,D FREOERICK COUNTY ci ANNING & DEVELOPMENT Datc rcvisi r=ivod Date approved Incomplete Date rc%,iewcd we l • ! DFDEC'i6 �2004E Document Approval Form I PLANNING &ICE T T PLEASE REVIEW THE ATTACHED . DOCUMENT. IF THIS DOCUMENT MEETS YOUR APPROVAL PLEASE INITIAL PROVIDE THE DATE AND TIME OF YOUR APPROVAL. 117 THIS DOCUIITENT DOES NOT MEET YOUR APPROVAL PLEASE PROVIDE C'OAIMENTS AS TO WHAT YOU WOULD LIKE TO IL VE COMPLETED. 'FNITIALS DATE & TIME DCandic David Mark Susan Eric COMMENTS: Received by Clerical Staff (Date &Time): N p �o © to �C/D� O O N >, ( V] O � IIlIIII b0 ~ ' � I J IIIII '. DATE S Z ��' RECEIVED FRDMN ADDRESS—:)—' No. 5045 J `I C�- a2 b03 S $ 102,0, 4 Q •� o s• -• r AMT. OF I CASH ACCOUNT AMT. PAID O CHECK VI FCE BADUE I BY C U ORDER