APPLICATION
, ........;....;If
.~...-' CITY OF BOYNTON BEACH, FLORIDA
COMMUNITY APPEARANCE BOARD
REVIEW APPLICATION
PROJECT NAME: Boynton Amoco #60617
PROJECT ADDRESS: NE Corner of Winchester Park Boulevard and Boynton Beach
BRIEF DESCRIPTION OF WORK: Constructi on of a convenience store with gas
one-bay automatic car-wash.
OWNER: Amoco 01 I Company "'
AGENT: Kilday & Associates, Inc.
APPLICATION TYPE
(Xf Site Plan
( ) site Modification
PLEASE PRINT OR TYPE
( ) Sign
( .) other
CAB MEETING DATE:
FILE NO.: <<"".5
RECEIPT NO.:
RECEIVED BY: ~j) ~fP.Jt
Boulevard.
sales and a
Phone Number: (4UI ) 743-9988
phone Number: (407) 689-5522
FAX NUMBER 407 689-2592
PRESENT THE PROJECT TO THE BOARD.
A REPRESENTATIVE OF THE PROJECT MUST
REPRESENTATIVE: Ki eran J. Kil day/Kil day & Assoc. Phone Number: (4QL) 689-5522
ADDRESS: 1551 Forum Place. Bldg.100A West Palm Beach. FL 33401
Street City state Zip Code
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - -
= = = = = = = = = = =
Identify the type of architectural ~heme that is specified on the community
Design District Boundary Map for your project location. Where compliance
with the Community Design Plan is required, the building(s) and/or
structure(s) proposed for the site shall be designed to comply with the
appropriate architectural design theme. On-site and off-site landscaping
shall comply with the Community Design plan landscape requirements. The
requirements of the Boynton Beach community Design Plan are specified in
Chapter 7.5, Article V of the Boynton Beach code of Ordinances.
ARCHITECTURAL THEME
CHECK ONE:
[] COASTAL VILLAGE [~MEDITERRANEAN/SPANISH [] MODERN [] NOT APPLICABLE
= = = = = = = = = - - = = = = = = = = = = = - - = = = = = = = = = = = = = =
Complete the following information foT. the proposed project and ensure that
the same information is identified on all plans submitted for the proposed
project including colored elevation view drawings.
Note: Color samples are required.
EXTERIOR SURFACE
c
C
ROOFING
CANOPY
CANOPY ;BEAMS
CANOPY COLUMNS
MECH. SCREENING
FASCIA
DECORATIVE MOLDING
SOFFIT
BEAMS
COLUMN.S-
TILE
DECORATIVE MOLDING
WALLS
GLASS WALLS
BANDS/RAISED
BANDS/RECESSED
VENEER
TILE
DECORATIVE TRIM
SHUTTERS
VENTS
GUTTERS/LEADERS
MECHANICAL EQUIP.
DECORATIVE LIGHTS
DOORS/OVERHEAD
SWINGING
DOOR TRIM
DOOR FRAME
rl,
MATERIAL
Spanish "s" Tile
Spanish "5" Tile
n/a
Steel Tubing
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Smooth Stucco
n/a .
nfa
n/a
n/a
n/a
n/a
n/a
n/a
n/il
n Iii
ni'a
nfa
Aluminum
COLOR:NAME.NUMBER
Terra Cotta (Ag-1) Gory Roof Tile
Terra Cotta (AG-1) Gory Roof Tile
Amoco Grey #26 (Glidden #79-48)
L1ght Ian by Benjamin Moore #143
Grey E.S.P.
Grey E.S.P.
Aluminum
Page 1 of 2
t
-
,.
- _pO"___ ~. vu. }Jll:,,';Ill mgnway system are such
that overhead signs will have value at many locations. The factors
justifying the erection of overhead sign displays are no ------~finable in
specific nu,n"-:al terms, but the following condihvlls deserve
consideration:
1. Traffic volume at or near capacity
2. Complex interchange design
...
3. Three or more lanes in each direction
4. Restricted sight distance
S. Closely spaced interchanges
6. Multi-lane exits
7. Large percentage of trucks
8. Street lighting background
9. High speed traffic
10. Consistency of sign message location through a series of
interchanges
11. Insufficient space for ground mounted signs
12. Junction of an Interstate route with another freeway
13. Left exit ramps
The existence of anyone or more of the conditions listed does not
automatically justify the use of overhead signs. Some of the elements
listed above can be made less critical by close coordination between design
and operation.
2A-23 Height
Signs erected at the side of the road in rural districts shall be mounted at
a height of at least 5 feet. measured from the bottom of the sign to the near
edge of the pavement. In business. commercial and residential districts
where parking and/or pedestrian movement is likely to occur or where
there are other obstructions to view, the clearance to the bottom of the
sign shall be at least 7 feet. The height to the bottom of a secondary sign
mounted below another sign may be 1 foot less than the appropriate height
specified above.
The height requirements for ground installations on expressways vary
somewhat from those on conventional streets and highways. Directional
signs on expressways shall be erected with a minimum height of 7 feet
(from the level of the near edge of the pavement to the bottom of the sign).
If. however, a secondary sign is mounted below another sign, the major
sign shall be at least 8 feet and the secondary sign at least 5 feet above the
level of the pavement edge. All route markers and warning and regulatory
signs on expressways shall be at least 6 feet above the level of the pavement
2A-9
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A parcel of I a-n.d lying in' S.ect j on 30. Townsh j p45 South, Ran'ge 4.3 :'~a.st,.~';Pa I.mc':',;.:';:~;r".'';;/'~:
Beach County, F lor j d a. S a'J d parcel be j n g a portion of Tracts A a n dB;' . al. 0 c k: 3. .:.. ,-(;~""
of "PALM BEACH FARMS COMPANY PLAT NO.8 OF SECTION 30, .TOWNSHIP 45 SOUTH,' RANGE
43 EASP, according to the plat thereof as recorded in Plat Book 5, at rage 73,
of the Publ ic Records of Palm Beach County, Florida.
Said land being more particularly described as follows:
Commencing at the Northeast corner 'of Section 30, Township 45 South, Ran~e 43
East; Thence with a bearing of S. 87032' 4rW., along the North I ine of said
Section 30, a distance of 60.00 feet to a point on the West Right-of-Way.1 ine
of Congress Avenue; Thence continue along the aforementioned course extended a
distance of 733.74 feet to a point; Thence with a bearing of S.01018'43DE.,
along a I ine lying 120 feet West of and parallel with the East I ine of sa.id
Tracts A and B, Block 3, of the above described Plat of "PALM BEACH FARMS
COM PAN Y P L A T NO.8", a d i s tan ceo f 25. 00 fee t tot h e Poi n t 0 f 8 e gin n i n g crf
Parce I of I and here i nafter to be descr i bed: Thence cant i nue a long the afare-
men t ion e d par a I I e I I i n e , a d i s tan ceo f 1 91. 04 fee t to a poi n t 0 fin' t e r s e c t ion
with the North Right-at-Way I ine of Boynton Beach Boulevard (now known as Ne~
Boynton West Road - State Road No. 804); Thence with a bearing of S.8r32'47IW.,
along the North Right-of-Way I ine of Boynton Beach Boulevard. a distance Qf
168.43 feet; Thence with a bearing of N. 46052'58"W., a distance of 35.71 feet to
a point of intersection with the East Right-of-Way I ine of Winchester Park
Boulevard; Thence with a bearing of N.OP18'43DW., along the Easterly Right-of-
Way I ine of Winchester Park Boulevard, a distance of 165.54 feet to a point;
Thence with a bearing of N.87032'47DE., along a line lying 25.00 feet South of
and parallel with the North I ine of said Section 30, a distance of 193! 94 feet
to the Point of Beginning. Lying and being situated in Palm Beach County,.!
Florida.
(2BVI>~Y ,J
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CITY OF BOYNTON BEACH, FLORIDA
PLANNING & ZONING DEPARTMENT
SITE PLAN 1\PPROVAL 1\PPLICATION
Site Plan - Major Modification to Existing Site
Application Accept~nce Date:
Fee Amount Paid: ~ 57JO. 1/27
Receipt Number: 2> () 1- '
aj)o
This application must be filled out completely and accurately and submitte
in one (1) copy to the Planning Department. Incomplete applications will
be processed.
I I
Please print legibly or type all information.
I . GENERAL INFORMATION
1.
Project Name:
Boynton Amoco #60617
2. Applicant's name (person or business entity in whose
name this application is made):
Amoco Oi 1
1254 Holly Cove Drive
Address:
Jupiter FL
33458
(Zip Code)
Phone:
FAX:
3. Agent's Name (person, if any, representing applicant):
Kilday & Associates
Address:
1551 Forum Place, Building 100A
West Palm Beach, FL 33401
407-689-5522
(Zip Code)
FAX: 407-689-2592
Phone:
4. Property Owner's (or Trustee's) Name: Winchester, Winchester, Zeiher
& Schroeder.
c/o Schroeder & Larche, P.A.
One Boca Place, Suite 319 Atrium
2255 Glades Road
Boca Raton FL 3343J-7313
FAX:
(Zip Code)
Address:
5. Correspondence address (if different than applicant or agent)*:
* This is the address to which all agendas, letters, and
other materials will be mailed.
PLANNING & ZONING DEPARTMENT - November, 1991
A:SitePlan
Revised and Re-submitted
May 15, 1992
(2 )
. .
6. What is applicant's interest in the premises affected?
(OWner, buyer, lessee, builder, developer, contract
purchaser, etc.) Buyer
7. street address or location of site: Northeast corner of Boynton
Beach Boulevard & Winchester Par~ Boulevard.
8. Property control #:
Legal description of site:
I I
See Attached Exhibit'A'
9. Intended use(s) of site:
Food Store and Gasoline Sales with Automatic Carwash.
10. Developer or Builder:
Amoco Oil Company
11. Architect:
Madison Industries, Inc.
12. Landscape Architect:
Kilday & Associates
13. Site Planner:
Kilday & Associates
14. Engineer:
M D M Engineering
15. Surveyor:
J.H. Manucy, Inc.
16. Traffic Engineer:
17. Has a site plan been previously approved by the City
Commission for this property? No,
N/A
18. Estimated construction costs of proposed improvements shown on
this site plan: $900,000.00
PLANNING & ZONING DEPARTMENT - November, 1991
A:SitePlan
. .
(3 )
II. SITE DATA
The following information must be filled out below and must
appear, where applicable, on all copies of the site plan.
1.
2.
3.
Land Use Category shown in
the Comprehensive Plan
LRC
Zoning District
C3
Area of site
0.844
acres
36768.03
sq. ft.
4. Land Use -- Acreage Breakdown
a.
Residential, including -0-
surrounding lot area of
grounds
Recreation Areas * -0-
(excluding water area)
acres
'% of si'
acres
% of si
b.
c.
Water Area -0-
acres
% of si1
d.
0.844
-0-
acres
% of si1
Commercial
100
% of si1
acres
e.
Industrial
f.
Public/Institutional
-0-
acres
% of si1
g.
Public, private and
Canal rights-of-way
Other (specify)
acres
% of sit
-0-
acres
% of sit
-0-
h.
i.
Other (specify)
-0-
acres
% of sit
j .
Total area of site
0.844
acres
100
% of sit
* including open space suitable for outdoor recreation, and
having a minimum dimension of 50 ft. by 50 ft.
5. Surface Cover
a.
acres
b.
* c.
Ground floor building 0.047
area ("building footprint")
5.6
% of sit
Water area
-0-
% of sit
-0-
acres
Other impervious areas,
including paved area of
public & private streets,
paved area of parking
lots & driveways (ex-
Cluding landscaped areas),
and sidewalks, patios,
decks, and athletic
courts.
*0.57
-8,:68:1:-
*67.5
-H-;zu
acres
% of sit
3f< d.
% of sit
*0 . 617
Total impervious area -8,:648-- acres
*72 . 8
-7'6-;8-
*- e.
*~054
Landscaped area -9:-929- acres
inside of parking lots
(20 sq. ft. per interior
parking space required -
see Sec. 7.5-35(g) of
Landscape Code).
*6.3
-2:-4-
% of sit
'A.:SitePlan
PLANNING & ZONING DEPARTMENT - November, 1991
*INDICATES ITEMS THAT HAVE CHANGED PER CITY STAFF COMMENTS
5-13-92
( ~ )
f. Other landscaped areas, 0.176 acres 20.8 % of sit
g. other pervious areas,
including golf courses,
natural areas, yards, and
swales, but excluding -0- -0-
water areas acres % of sit
*0.227 *27.2
"* h. Total pervious areas ~:-l-%- acres -l3?'l % of sit
i. Total area of site 0.844 acres 100 % of sit
I I
6. Floor Area
a. Residential -0- sq. ft.
b. Commercial/Office 1248 sq. ft.
c. Industrial/Warehouse -0- sq. ft.
d. Recreational -0- sq. ft.
e. Public/Institutional -0- sq. ft.
f. other (specify) 792 sq. ft.
Car Wash
g. Other (specify) sq. ft.
h.
Total floor area
2040
sq. ft.
7. Number of Residential Dwelling units
a.
Single-family detached
Duplex
Multi-Family (3 + attached
dwelling units)
(1) Efficiency
(2) 1 Bedroom
(3) 2 Bedroom
(4) 3+ Bedroom
N/A
sq. ft.
sq. ft.
b.
c.
dwelling units
dwelling units
dwelling units
dwelling units
d.
Total multi-family
dwelling units
e. Total number of dwelling units
8.
9.
Gross Density
N/A
dwelling units per acre
Maximum height of structures on site
16
feet
1
storie
10. Required off-street parking
a.
Calculation of required
number of off-street
parking spaces
1 space per 20a s.f. of retail
b.
Off-street parking spaces
provided on site plan
7 spaces
1248/200 = 6.24 = 7 spaces
PLANNING & ZONING DEPARTMENT - November, 1991
*INDICATES ITEMS THAT HAVE CHANGED PER CITY STAFF COMMENTS
5-13- 92
A:SitePlan
III. CERTIFICATION
(5 )
(I) (We) understand that this application and all papers and
plans submitted herewith become a part of the permanent
records of the Planning and Zoning Board. (I) (We) hereby
certify that the above statements and any statements or
showings in any papers or plans submitted herewith are true to
the best of (my) (our) knowledge and belief. This application
will not be accepted unless signed according to the
instructions below.
M~JL~~:tJ .
Signature of OWner(s) or Trustee,
of Authorized Principal if property
is owned by a corporation or other
business entity.
IV. AUTHORIZATION OF AGENT
~/~~
~.~ /~~____;r ~/2.. ,"/P"~ ~ ."ll-bAt
Signature?6f Authorized Agent
:e:-..;e.. ~ 7 d::...
, Date
..:J";;J J. .:;;:z 7 I I Cj" "i .:z..-
Date
(I) (We) hereby designate the above signed person as (my)
(our) authorized agent in regard to this application.
AffJt' A/"~LI:;
Signature of OWner(s) or Trustee,
or Authorized Principal if property
is owned by a corporation or other
business entity.
SPACE BELOW THIS LINE FOR OFFICE USE ONLY
Review Schedule:
z. ~ ~ ?-2..
t7 Date
Date Received
Technical Review Board
Planning & Zoning Board
Community Appearance Board
City Commission
Stipulations of Final Approval:
Date
Date
Date
Date
Other Government Agencies/Persons to be contacted:
Additional Remarks:
PLANNING & ZONING DEPARTMENT -'November, 1991
A:SitePlan
.'
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LE.GA'L DESCR I PT ION'. " ':"',.' ...,-.,... "i':)"''1,?1<' ~~'"
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A parce I of I.an.d I y i ng inSect i on 3D, Townsh i p 45 South, ,Range' 43 .~asJ, ";;'P~l~',-'~;}:
Beach County, Florida. Said parcel being a portion of Tracts A and 'S,';;,:Sl'oCk';:3>
of M PALM BEACH FARMS COMPANY PLAT NO. 8 OF SECT I ON 3D, TOWNSH I P 45 SOUTH, RANGI
43 EASP, accord i ng to the p I at thereo f as recorded in P I at Book 5. at Page 73,
of the Public Records of Palm.Beach County, Florida.
Said land being more particularly described as follows:
Commencing at the Northeast carner of Section 3D. Township 45 South. Range 43
East; Thence with a bearing of S.B7032'4rW., along the North line of said.
Section 30, a distance of 60.00 feet to a point on the West Right-of-Way line
of Congress Avenue; Thence continue along the aforementioned course extended a
distance of 733.74 feet to a point; Thence with a bearing of S.01018'43-E.,'
along a line lying 120 feet West of and parallel with the East line of said
Tracts A and B, Block 3, of the above described Plat of "PALM BEACH FARMS
COMPANY PLAT NO. Bn, a distance of 25.00 feet to the Point of Beginning of
Parcel of land hereinafter to be described: Thence continue ~Iong the afore-
mentioned parallel I ine, a distance of 191. 04 feet to a point of intersection
with the North Right-of-Way I ine of Boynton Beach Boulevard (now known as New
Boynton West Road - State Road No. 804); Thence with a bearing of S.87032'47.W.
along the North Right-of-Way I ine of Bcynton Beach Boulevard. a distance of
168.43 feet; Thence with a bearing of r:. 46052'58uW., a distance of 35.71 feet 1
a point of intersection with the East Right-of-Way I ine of Winchester Park
Boulevard; Thence with a bearing of N. 01018' 431111., along the Easterly night-of-
Way I ine of Winchester Park. Boulevard, a distance of 165.54 feet to a point;
Thence with a bearing of N. 87032' 4rE.. fllong a I ine lying 25.00 feet South of
and parallel with the North I ine of said Section 30, a distance of 193. 94 feet
to the Point of Beginning. Lying and being situated 1n Palm Beach County,
Florida.
winchester, Winchester, Zeiher & Schroeder, Partnership
I, Elsie Winchester,
General Partner, hereby authorize
Bill R. Winchester, General Partner, to sign all documents
pertaining to Annexation, Land Use Amendment, Rezoning,
Site Plan Approval, and Variance to Zoning Code applications
for property described on attached Exhibit "A".
~/; , --J-- 11 - ( ~
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Elsie Winchester, 'General Partner
STATE OF:
COUNTY OF:
I HEREBY CERTIFY THAT ON THIS ...?;:: da;;~'
199 1, before me personally appeare~~ './ {l, .
to me known to be the person(s) described in and who executed
the foregoing instrument.
WITNESS my hand and official seal in the State and County the
day and year last aforesaid.
(NOTARIAL SEAL)
~~lf~f'G ,/ "- ~--/
~Of:
My Commission Expires:
Notary Publit, Stote of Florida
My Commission Expirl!s Od. 1, 1993 .
Bonded Thru Troy Fain. Insurance Inc. '
winchester. winchester. Zeiher & Schroeder. Partnership
I, MICHAEL A. SCHROEDER and LESLIE C. SCHROEDER, General
Partner, hereby authorize Bill R. Winchester, General Partner, to
sign all documents pertaining to Annexation, Land Use Amendment,
site Plan Approval, and Variance to zoning Code
property described on attached Exhibit "A".
M' hael A. Soeder, Ge Partner
,'~(!~AliPLk .
~eslie C. Schroeder, General Partner
STATE OF FLORIDA )
)ss:
COUNTY OF PALM BEACH)
The foregoing instrument was acknowledged before me this~ ~
day of r~~, , 19~(LDy MICHAEL A. SCHROEDER and LESLIE C.
SCHROEDER, who are personally known to me/or have produced
"-as identification and did not take an oath.
_.
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---
Printed Name of Notary
Notary Public State of Florida
My Commission Expires:
My Commission Number:
...~;;:;%;.. OfF~C!,''',l SEAL
.. of' ..~ ". 'j r'........, , YN'" Joel""
. ~(:r . ".,..,,oj 'n.. '''' .;:)
f ~t~to1..'.. i f;h11....,r'l n ,{.'!i~ ;:;tl'l~e of Florida
\. ... : ''',.! C,)rf'["':';<i'cn No. CC 125028
...:~-~.~~t~..,:::~/' t~~~r.,'~fJ)1J ,"'bg~st 27. 1995
(Winchest\Authoriz)
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JAt'~-2121-'92 MOt~ 17:26 ID:KILDAH 4, A:-50C:IA-TES It:.L li'-';-")I-,--Il~,I,-,W
I ~ ~ _ TEL NO:407-689-2592 -
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~;nchester. winchester, Zeih~r , Sohroeder, Partnarahi~
I, William A. Zeiher,
General partner, hereby autho~ize
Sill R. Winohester, General Partner, to sign all documents
pertaining to Annexation, Land use Amendment, Rezoning,
Site Plan Approval, and Variance to Zoning Code applications
for property descKbed on attach~d Exhibit HA".
STATE OF& FLORIDA
COUNTY OF. BROWARD
I HEREBY CERTIFY THAT ON THIS 23rd
day of, Jan~
I
1992, before me personally appeared. WILLIAM a. ZEIH~F
to me known to be the person'.) described in and who executed
the foregoing instrument.
WI~BSS my hand and off1cial seal in the State and county the
day and year last aforesaid.
(NOTARIAL' SEAL)
,~\'" -
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/.-(I.~-t: It.."'. _ ,..\ tL 2 IJ-ti rctf-...L-
Ji~tary Public ~ Jearune Barbanoa~
State of:
My Commission
,;, .,,~,. -. .
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Expires .NOTARY PUBLIC STATE OF FLORIDA
~y COMMISSION EXP. MAY 4,1993
BONDED THRU GENERAL IUS. UND.
C' ,~
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File No.: -11. -
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CO{TlJ'l1"'n~.ty' Appearance BOc..L-l ~ Page 2
WINDOW GLASS
WINDOW FRAME
WINDOW TRIM
SCREEN ENCLOSURE FRAME
RAILINGS
AWNING
SUPPORT(S)
WALL SIGN FRAME
FACE
COpy
SITE WALL
TRIM
FENCE
DUMPSTER ENCLOSURE
FREE STANDING SIGN
SUPPORT
FRAME
FACE
COPY
DECORATIVE SITE
LIGHTING POLE/FIXTURE
DECORATIVE SITE
PEDESTRIAN LIGHTING n/a
DECORATIVE DRIVING SURFACE
DECORATIVE WALKING SURFACE
OTHER
Aluminum
Grey E.S.P.
n/a
n/a
n/a
n/a
8" CBS Stucco Finish
Light Tan bY Beniamin Moore #143
Light Tan by Benjamin Moore #143
Block
Wall with Stucco
Aluminum
ilLS!" Heritaqe Series
n/a
n/a
SUBMITTAL REQUIREMENTS: The following shall De incorporated as part of the Community
Appearance Board application submittal:
1. Application form filled out completely and legibly.
2. Application fee of $50.00 (payable to City of Boynton Beach)
3. Submit a scaled locator map that identifies the location and perimeter boundary of the
site and the surrounding roads and current zoning districts including the district of
the subject property. The map shall show and identify by name the roads surrounding
the site and the roadway path that links the site to the closest arterial road with
the names of the roads and arterial road(s) identified. The map shall show the zoning
district line and the title of the zoning districts that abut the perimeter of the
zoning district where the subject property is located. The map shall have the North
compass direction and scale identified. Haximum size of locator mnp is 8 1/2" by 14".
4. Submit color photographs of the buildings on the site that are to remain in their
existing condition and photos of existing buildings that are located on the sites that
abut the perimeter of the subject property. The minimum size is 8" by 10". Each
photograph shall be labeled to identify the location of the e:<isting structures with
respect to the location of the proposed project.
5. Submit a 8-1/2" x 11" transparency of the landscape site plan drawing to be used on an
overhead projector at board meetings.
6. Submit colored elevation view drawings - a colored duplicate copy of all drawings of
the elevation views of each side of all buildings and signage associated with the
pt'oject. The colot'ed elevation views shall match the elevations shown in the
documents that where submitted for site plan review. The applicable exterior surfaces
as identified above shall be colored with the color name and associated color
reference number identified. The type of exterior surface material shall be identified
next to the associated color. The colored elevation drawings shall have compass
direction or title of the side of the building identified. Th,~ title block of the
o.~iginal drawing shall be shown. The maximum size is 24" by 3(,". Do no submit on board
of any kind.
7 Submit color samples as an example of the proposed colors. E8~h sample shall have
attached a label that identi~les the color by name and numeri~al/letter code from an
established color chart.
8. Where a specific exterior surface is not applicable to the project, signify by placing
a "N/A" on the appropriate line.
9. Submit a copy of the legal description of the subject property on an 8 1/2" by 11"
sheet. of paper.
COMMUNITY APPEARANCE BOARD
Kieran J. Kilday/Kilday & Associate
Name of Applicant Signa
CAB Chairperson/Acting
Chairperson
A:CABAPP.SDD 2/92
S/~z.
ate
Approved/Denied
Name
Date