APPLICATION
CAULFIELD & WHEELpr- 'NC.
4. ~ 7301A West Palmetto Park ~,j
~~ SUite lOOA
Boca Raton, Florida 33433
[L@LfLf@C\. 2)[? Lfw&[m~~DLfLf&[L
(561) 392-1991
DATE I JOB NO.
9/9/97 3213
ATTENTION
Greg Miklos
RE:
GUARDIAN STORAGE
TO
Miklos & Associates
WE ARE SENDING YOU ~ Attached
C Under separate cover via
the following items:
>
o Shop drawings
o Prints
o Plans
o Samples
o Specifications
o Copy of letter
o Change order
o
COPIES DATE NO. DESCRIPTION
14 Revised Preliminary Development Plan
14 Boundary Survey
12 Drainage Calculations
12 Fire Flow Calculations
THESE ARE TRANSMITTED as checked below:
o For approval 0 Approved as submitted
~ For your use 0 Approved as noted
> o As requested 0 Returned for corrections
o For review and comment 0
o FOR BIDS DUE 19_
REMARKS
o Resubmit
copies for approval
o Submit
copies for distribution
o Return
corrected prints
o PRINTS RETURNED AFTER LOAN TO US
COpy TO
.----
///~~~._..~'----"'~"r
'~'/'
SIGNED: L./' ~
If enclosures are not as noted, kindly notify us at once.
John F. Wheeler, P.E.
L
PROJECT NAME: GUARDIAN STORAGE
LOCATION: NORTHEAST CORNER OF CONGRESS A VE AND 35TH AVE
COMPUTER ID: GUARDIAN STORAGE\NWSP
I FILE NO.: NWSP 97-017 I TYPE OF APPLICATION: NEW SITE
PLAN
AGENT/CONTACT PERSON: APPLICANT: TOUHEY ASSOC
GREGORY MIKLOS (Mr. Carl Touhey)
PHONE: (561) 392-6762 PHONE: (518) 438-3521
FAX: (561) 750-8465 FAX: (518) 452-0600
ADDRESS: 2263 N.W. BOCA RATON ADDRESS: PINE WEST PLAZA, BLDG#2
BLVD., SUITE 112 WASHINGTON AVE. EXTENSION
BOCA RATON, FL 33431 Albany, NY 12205
DATE RECEIVED: 7/23/97 DATE:
1ST REVIEW COMMENTS DUE: 8/8/97
PUBLIC NOTICE:
ADMINISTRATIVE TRC MEETING: 8/ .5/97
TRC MEETING: 8/11J97
RESUBMITTAL DATE: 9/9/97
2l'iD REVIEW COMMENTS DUE:
LAND DEVELOPMENT SIGNS POSTED:
PLANNING & DEVELOPMENT BOARD 10/14/97
MEETING:
CITY COMMISSION MEETING: lo.~/97
COMMENTS:
S:\FORMS\PROJECT TRACKING INFO
tTfie City of
'Boynton 'Beacli
100 'E. fJ3oynton fJ3eadi fJ30ufevara
p.o. fJ3l1.{310
fJ3ognton fJ3eadi, :JforUfa 33425-0310
City :Haft: (561) 375-6000
:J5IX: (561) 375-6090
July 24, 1997
Mr. Dan Weisberg, Senior Engineer
Palm Beach County Traffic Division
Department of Engineering and Public Works
P.O. Box 21229
West Palm Beach, Florida 33416
Re: Traffic Study: Guardian Storage
Congress Avenue and 35th Avenue
File # NWSP 97-017
Dear Mr. Weisberg:
The enclosed trip generation analysis for the Guardian Storage at Congress Avenue and 35th
Avenue site dated July 11, 1997, prepared by Yvonne Ziel Traffic Consultants, Inc. was
received by the Planning and Zoning Division recently for the above-referenced application.
Please review the enclosed information for conformance with the County's Traffic Performance
Standard Ordinance.
If you have questions regarding this matter, please call me at (561) 375-6260, otherwise please
send me your written comments/approval to the above address, with a copy of your written
response to AI Newbold, Acting Development Services Director also at the same address.
Sincerely,
,.r-'
,
,",* /
'~'~,;_?~-f~._ -
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Tambri J. Heyden, AICP
Planning and Zoning Director
T JH:bme
cc: AI Newbold
w/ attachment
Central File
s:\projects\Guardian Storage\traffic
5'lmericas (jateway to the (julfstream
APPLICATION ACCEPTANCE DATE: -
RECEIVED BY -''\FF NI~NBER:
, \l=~0")0 J.w ~\ ~~
RECEIPT NUMB!:.,,:
1\J\..~se en -()\(',
~I~NNING & ZONJNG DEPARTMENT
(~l~s
FEE PAID:
SITE PLAN REVIEW APPLICATION
FOR
NEW SITE PLANS & MAJOR MODIFICATIONS TO EXISTING SITE
Application Acceptance Date:
Fee Paid:
Receipt Number:
This application must be filled out completely, accurately and submitted as
an original to the Planning and Zoning Department. Twel ve complete,
sequentially numbered and assembled sets of plans including a recent survey
and appropriate fee shall be submitted with the application for the initial
process of the Site Plan Review procedure. An incomplete submittal will not
be processed.
Please print legibly (in ink) or type all information.
I. GENERAL INFORMATION
1.
Project Name:
GUARDIAN STORAGE
CONGRESS AVENUE, BOYNTON BEACH, FLORIDA
2. Applicant's name (person or business entity in whose name this
application is made) :
TOUHEY ASSOCIATES (MR. CARL TOUHEY)
Address:
PINE WEST PLAZA, BUILDING #2, WASHINGTON AVE. EXTENSION
ALBANY, NEW YORK 12205
Phone:
(518) 438-3521
452_0600(Zip Code}
Fax: (518)
3. Agent's Name (person, if any, representing applicant):
Address:
GREGORY MIKLOS, ARCHITECT
2263 N.W. BOCA RATON BLVD., SUITE 112
BOCA RATON, FLORIDA 33431
p.11one :
(561) 392-6762
(Zip Code)
Fax: (561) 750-8465
4. Property Owner's (or Trustee's) Name:
william H. Baker c/o William F. Koch, Jr.
Address:
Atlantic Avenue, Delray Beach, Florida
..
(Zip Code)
Phone:
Fax:
5. Correspondence to be mailed to agent only; if no agent, then to
applicant unless a substitute is specified below:*
AGENT ONLY
SEE ADDRESS ABOVE
*This is the one address to which all agendas, letters and other
materials will be mailed.
.ji .ag:e -2
Site Plan Review Ap.~4cation
6.
What is applicant's interest in the premises affected? (owner, buyer,
lessee, builder, developer, contract purchaser, etc.)
CONTRACT PURCHASER
}l ;t:. .Cd2~ r/() "S.LJ .T~~~
Street address or location of site: -4 CON~\1~
7.
8 .
Property Control #:
{}O - J/.~ . ~ -Oc,- /" ()O -LrO /3()~/)
~ . .-~
Legal description of site: A TRACT OF LAND LYING IN THE
SOUTHWEST ~ OF THE NORTHWEST ~ OF SECTION 5 TOWNSHIP 46 SOUTH,
RANGE 43 EAST, PALM BEACH COUNTY, FLORIDA, BEING MORE FULLY
DESCRIBED ON SITE PLAN.
9. Intended use(s) of site: MINI STORAGE
10. Developer or Builder: TOUHEY ASSOCIATES
11.
Architect:
MIKLOS AND ASSOCIATES
12.
Landscape Architect:
JERRY TURNER ASSOCIATES
15.
Surveyor:
MIKLOS AND ASSOCIATES
CAULFIELD AND WHEELER (CIVIL)
TECTON ENGINEERS (STRUCTURAL)
CAULFIELD AND WHEELER
13.
Site Planner:
14.
Engineer:
16. Traffic Engineer:
YVONNE ZIEL
17.
Has a site plan beenNBreviously approved by the City Commission for
this property?
18.
Estimated construction costs of proposed improvements shown on this
site plan: 1.5 MILLION (APPROXIMATELY)
Planning and Zoning Department - Rev. 3/18/97
S:\PLANNING\SHARED\WP\FORMS\APPS\NWSP\SITEPLAN,WPD
Page 3
Site Plan Review Ap~tcation
II. SITE DATA
The following information must be filled out below and must appear, where
applicable, on all copies of the site plan.
1. Land Use Category shown in the Comprehensive Plan
2. Zoning District M-l
3. Area of Site 3.78 acres 164,656.8
4 . Land Use -- Acreage Breakdown
b.
c.
d.
g.
h.
i.
j .
5 .
sq. ft.
a.
Residential, including
surrounding lot area
of grounds
% of site
acres
Recreation Areas *
(excluding water area)
Water Area
% of site
% of site
% of site
g. of site
0
g. of site
0
% of site
% of site
acres
acres
Commercial
acres
e.
Industrial
3.78
100%
acres
f.
Public/Institutional
acres
Public, Private and
Canal rights-of-way
acres
Other (specify)
acres
Other (specify)
% of site
acres
Total area of site
% of site
acres
* including open space suitable for outdoor recreation, and having
a minimum dimension of 50 ft. by 50 ft.
Surface Cover
.47
% of site
a.
b.
c.
1. I~
Ground floor building (77622.5)
area ("building footprint")
acres
Water area acres
% of site
Other impervious areas, including
paved area of public & private
streets, paved area of parking
lots & driveways (excluding
landscaped areas), and
sidewalks, patios, decks,
and athletic courts. acres
% of site
d.
Total impervious area
1.31
(57150)
.34
% of site
acres
Planning and Zoning Department - Rev. 3/18/97
S:\PLANNING\SHARED\WP\FORMS\APPS\NWSP\SITEPLAN,WPD
.page .4
Site Plan Review ApY'~-~ cation
g.
e.
Landscaped area
inside of parking lots
(20 sq. ft. per interior
parking space required -
see Sec. 7.5-35(g) of
Landscape Code) .
% of site
acres
f.
Other landscaped areas,
% of site
acres
Other pervious areas, including
golf course, natural areas,
yards, and swales, but excluding
water areas acres
% of site
h.
acres
% of site
Total pervious areas
i.
acres
3.78
% of site
Total area of site
6. Floor Area
a.
b.
c.
d.
e.
f.
g.
h.
Residential sq. ft.
Commercial/Office sq. ft.
Industrial/Warehouse sq. ft.
Recreational sq. ft.
Public/Institutional sq. ft.
Other (sJ]ecify) 77627.5 sq.
MINI ST RAGE ft.
Other ( specify)
sq. ft.
77627.5 sq. ft.
Total floor area
7. Number of Residential Dwelling Units
a. Single-family detached
b. Duplex
ft.
c. Multi-Family (3
(1) Efficiency
(2) 1 Bedroom
(3) 2 Bedroom
(4) 3+ Bedroom
dwelling units)
dwelling units
dwelling units
dwelling units
dwelling units
d.
e.
8 .
Total
dwelling units
y
of dwelling units
dwelling units per acre
15'
(1)
stories
9.
Maximum height of structures on site
feet
Planning and Zoning Department - Rev. 3/18/97
S:\PLANNING\SHARED\WP\FORMS\APPS\NWSP\SITEPLAN,WPD
Page 5
Site Plan Review AppJ~cation
10. Required off-street parkin9
a. Calculation of required
number of off-street
parking spaces
77627.5 + 800 = 97 CARS
Planning and Zoning Department - Rev. 3/18/97
S:\PLANNING\SHARED\WP\FORMS\APPS\NWSP\SITEPLAN.WPD
b.
Off-street parking spaces
provided on site plan
97 CARS
l
Page 6
Site Plan Review AprjAcation
III. CERTIFICATION
(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 Department (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.
~ a C'y
X L~~ ~, Yd'U~~
Signature of Owner(s) or rustee, of
Authorized Principal if property is owned by
a corpora or t er business entity.
('2,u2./~/f~7
--,
Date
IV.
/'
Agent
Date
) (W hereby designate the above signed person
authorized agent in regard to this application.
~ ~ <5. %:4
Signature of Owner(s) or Trustee,
or Authorized Principal if property is owned
by a corporation or other business entity.
as
(my)
(our)
Cb/7/ff7
Date
SPACE BELOW THIS LINE FOR OFFICE USE ONLY
Review Schedule:
Date Received
Technical Review Committee
Planning & Development Board
Community Appearance Board
City Commission
Date
Date
Date
Date
Stipulations of Final Approval:
Other Government Agencies/Persons to be contacted:
Additional Remarks:
Planning and Zoning Department - Rev. 3/18/97
S:\PLANNING\SHARED\WP\FORMS\APPS\NWSP\SITEPLAN,WPD
Page 7
Site Plan Review Ap~L~cation
RIDER TO SITE PLAN APPLICATION
The undersigned as applicant for Final Site Plan Approval does hereby
acknowledge, represent and agree that all plans, specifications, drawings,
engineering, and other data submitted with this application for review by the
City of Boynton Beach shall be reviewed by the various boards, commissions,
staff personnel and other parties designated, appointed or employed by the
City of Boynton Beach, and any such party reviewing the same shall rely upon
the accuracy thereof, and any change in any item submitted shall be deemed
material and substantial.
The undersigned hereby agrees that all plans, specifications, drawings,
engineering and other data which may be approved by the City of Boynton
Beach, or its boards, commissions, staff or designees shall be constructed in
strict compliance with the form in which they are approved, and any change to
the same shall be deemed material and shall place the applicant in violation
of this application and all approvals and permits which may be granted.
The applicant agrees to allow the City of Boynton Beach all rights and
remedies as provided for by the applicable codes and ordinances of the City
of Boynton Beach to bring any violation into compliance, and the applicant
shall indemnify, reimburse and save the City of Boynton Beach harmless from
any cost, expense, claim, liability or any action which may arise due to
their enforcement of the same.
READ, ACKNOWLEDGED AND AGREED TO this
, 19 97.
/7td day
~
of
<-- -~~
C/ -' v/VC
~A~ i.}t )1'~ tl'->iXJc~ D~~
Witness v
witne~LQ,^ ({JL~l
.~
& V~.~
Applicant
Planning and Zoning Department - Rev. 3/18/97
S:\PLANNING\SHARED\WP\FORMSIAPPS\NWSP\SITEPLAN.WPD
Page 8
Site Plan Review Ap~Ucation
NOTICE TO APPLICANTS FOR APPROVAL OF LAND
DEVELOPMENT ORDERS OR PERMITS
Please be advised that all applications for the following land development
orders and permits which are submitted on or after June 1, 1990 will be
subject to the City's Concurrency Management Ordinance, and cannot be
approved unless public facilities (potable water, sanitary sewer, drainage,
solid waste, recreation, park, and road facilities) would be available to
serve the project, consistent with the levels of service which are adopted in
the City's Comprehensive Plan:
Building permit applications for the construction of improvements which,
in and by themselves, would create demand for public facilities.
Applications for site plan approval.
Applications for conditional use approval.
Applications for subdivision master plan approval.
Applications for preliminary plat approval.
Applications for final plat approval.
Applications for rezoning to planned zoning districts.
Applications for revisions to any of the applications listed above,
which would incEease the demand for any public facility.
Any other application which, in and by itself, would establish the
density or intensity of use of land, or a maximum density or intensity
of use of land.
* Applications for development orders and permits submitted after February
1, 1990 and which generate more than 500 net vehicle trips per day, must
comply with the Palm Beach County Traffic Performance Standards
Ordinance, unless exempt from that ordinance.
Please be advised, however, that the following applications will be exempt
from the Concurrency Management Ordinance, pending final approval of this
ordinance by the City Commission:
Applications for the development of property which was platted on or
after January 13, 1978 and either the final plat or the preliminary plat
and Palm Beach County Health Department permit applications were
submitted or approved prior to June 1, 1990, and the use of the property
is consistent with the general use which was intended for the property
at the time of platting.
Applications for the development of property which was platted prior to
January 13, 1978, the area of the platted lots does not exceed 2 acres,
and the proposed use would not generate more than 500 net vehicle trips
per day.
Applications for building permit, if a s~te plan or c0nditional use
application was submitted prior to June 1, 1990 and subsequently
approved and the site plan or conditional use has not expired.
Planning and Zoning Department - Rev. 3/18/97
S:\PLANNING\SHARED\WP\FORMS\APPS\NWSP\SITEPLAN,WPD
Page 9
Site Plan Review AP:r-1....:i cation
Applications for the development of property
Development of Regional Impact, and which are
approved DRI.
within an
consistent
approved
with the
Applications for approval of final plats, if the preliminary plat gng
application for Palm Beach county Health Department permits for
utilities have been submitted prior to June 1, 1990.
Applications for revisions to previously approved development orders or
permits, which do not increase the demand for any public facility.
Please be advised that these exemption rules are tentative and will be
subject to final approval by the City Commission. If you have any questions
concerning the proposed Boynton Beach Concurrency Management Ordinance,
please contact the Boynton Beach Planning Department at (561)~375-6260.
Planning and Zoning Department - Rev. 3/18/97
S:\PLANNING\SHARED\WP\FORMS\APPS\NWSP\SITEPLAN.WPD
Page 10
Site Plan Review App-w cation
CHAPTER 4
SITE PLAN REVIEW
Section 7. Submission Requirements.
Each applicant shall submit to the Planning and Zoning Department the
following plans and exhibits in the number of copies specified by the
Planning and Zoning Department, together with a Site Plan Review application
and a fee adopted by resolution by the City Commission.
12 ASSEMBLED COPIES REQUIRED
A. Existing site characteristics map: A sealed survey, not bIder than six
months, showing all adjacent streets, alleys and driveways, and also
illustrating:
1. Existing natural features, including but not limited to lakes,
trees and other vegetation and soils and topography.
2. Existing buildings, building elevations, other structures,
including use, height, dimensions and setbacks.
3. Existing utility lines and all easements.
4. Existing elevations (corner, street and finished floor)
B. Site development plan:
1. A scaled drawing clearly illustrating proposed buildings and
other structures, and any existing buildings and structures
which are to be retained, including use, height, dimensions
and setbacks.
2. Proposed off-street parking spaces, driveways and sidewalks,
including location, dimensions and setbacks, traffic control
markings and signage.
3. Proposed fences and walls, including location, dimensions,
setbacks, height and material.
4. Proposed location of lighting on site.
5. Proposed dumpster location.
C. Landscape plan:
1. A separate scaled drawing (at the same scale as the site
development plan) prepared as required by state law clearly
illustrating proposed trees, shrubs, grass and
2. Proposed berms, watercourses and other topographic features.
3. A notation on method of irrigation.
Planning and Zoning Department - Rev. 3/18/97
S:\PLANNING\SHARED\WP\FORMS\APPS\NWSP\SITEPLAN.WPD
Page 11
Site Plan Review App.u cation
D. Architectural plan:
1. A scaled drawing clearly illustrating proposed building floor
plan and elevations, including height, exterior dimensions,
exterior color and materials.
2. A colored elevation drawing (not mounted) showing all
elevations of the building. (This submittal can be waived by
the Planning and Zoning Director when not applicable.)
E. Tabular Summary Containing:
1. Total gross project area by acreage and square footage and net
buildable land area in acres and square feet.
2. Total number of proposed residential units, including
characteristics by number of bedrooms and bathrooms and gross
square footage of each typical unit.
3. Proposed nonresidential floor type of use and total gross
square footage.
4. Square footage and percentage distribution of the total
proj ect site, including areas proposed for landscaped open
space, vehicular use areas, other paved areas, and building
coverage and total coverage.
5. Number and ratio of required and provided off-street parking
spaces and number of loading spaces.
6. Water bodies in acres and square feet.
7. Height of buildings.
F. Drainaqe plan:
1. A separate scaled drawing (at the same scale as the site
development plan) showing elevations, flow arrows, proposed
drainage structures, proposed treatment facilities, etc.
2. An engineer's certification in writing that drainage will
conform with all rules, regulations, codes, etc. including,
but not limited to, Chapter 6, Article IV, Section 5 of these
Land Development Regulations.
Planning and Zoning Department - Rev. 3/18/97
S:\PLANNING\SHARED\WP\FORMS\APPS\NWSP\SITEPLAN,WPD
~~
YVONNE ZIEL TRAFFIC CONSULTANTS, INC.
11440 86th St. North, West Palm Beach, Florida 33412
Telephone (561) 624-7262 . Facsimile (561) 624-9578
July 11, 1997
Mr. Michael W. Rumpf
Senior City Planner,
Planning and Zoning Department
City of Boynton Beach
100 East Boynton Beach Boulevard
Boynton Beach, Florida 33425
RE: Congress/SW 35 Avenue Mini-Warehouse
Dear Mr. Rumpf:
The subject project is located at the northeast comer of Congress Avenue and 35 Avenue. The
applicant is approval for a 77,622 square foot mini-warehouse project. Yvonne Ziel Traffic
Consultants, Inc. was retained to prepare a trip generation analysis.
Please find enclosed Tables 1 and 2 which provide the trip generation rates used and the resulting
trips. Trip generation indicates that the proposed project will generate 189 daily trips. Since the
daily trip generated are less than 200 daily trips, a complete traffic study is not required. Please
contact me if you have any questions.
Sincerely,
F C CONSULTANTS, INC.
Enclosure
Traffic Engineering and Planning
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APPLICATION TRACKING LOG
PROJECT TITLE:
GUARDIAN STORAGE
FILE #:
PROJECT LOCATION: NORTHEAST CORNER OF CONGRESS AVE AND 35TH AVENUE
TYPE OF APPLICATION: NEW SITE PLAN
NWSP 97-017
PUBLIC NOTICE REQUIRED: (Y IN) 0
REVIEWER'S NAME:
AGENT: GREGORY MIKLOS
JERZY LEWICKI
ADDRESS: 2263 NeW. BOCA RATON BLVD. STE 112. BOCA 33431
AGENT PHONE: (561) 392-6762
DATE REC'D: 7/23/97
AMOUNT:
12 SETS OF PRE-ASSEMBLED PLANS SUBMITTED FOR REVIEW:
2 OF 12 SETS SIGNED AND SEALED 0
SURVEY 0
LANDSCAPE PLAN 0
FLOOR PLAN 0
SITE PLAN WITH SITE DATA 0
APPLICATION/SUBMITTAL: DATE ACCEPTED:
FAX:
(561) 750-8465
RECEIPT NO.:
DRAINAGE PLAN
ELEVATION VIEW DRAWINGS
COLORED ELEVATIONS RECEIVED
MATERIAL SAMPLES RECEIVED
PHOTOGRAPHS RECEIVED
DATE DENIED:
DATE OF LETTER TO APPLICANT IDENTIFYING SUBMISSION DEFICIENCIES:
DATE OF SUBMITTAL ACCEPTANCE LETTER:
INITIAL 1ST REVIEW MEMO: DATE SENT: '7Ias-
o
o
o
o
o
MEMO NO. 97-396
1 ST REVIEW COMMENTS RECEIVED
UTIL.
P.W.
PARKS
FIRE
POLICE
PLANNING
BUILDING
ENGINEER
FORESTER
ECON. DEV.
COORD.
DATE OF LETTER SENT TO SENT TO APPLICANT IDENTIFYING TRC REVIEW COMMENTS:
PLANS
o
o
o
g-
O
RETURN DATE: 8/8/97
90 DAY CALENDAR DATE WHEN APPLICATION BECOMES NULL AND VOID:
DATE 12 COMPLETE (ASSEMBLED) SETS OF AMENDED PLANS SUBMITTED FOR 2ND REVIEW:
PRE-ASSEMBLED PLANS SUBMITTED FOR REVIEW:
AMENDED APPLICATION 0
2 OF12 SETS SIGNED AND SEALED 0
SURVEY 0
LANDSCAPE PLAN 0
FLOOR PLAN 0
SITE PLAN WITH SITE DATA 0
2ND REVIEW MEMO: DATE SENT: qt, {q1
DRAINAGE PLAN
ELEVATION VIEW DRAWINGS
COLORED ELEVATIONS RECEIVED
MATERIAL SAMPLES RECEIVED
TRANSPARENCY RECEIVED
PHOTOGRAPHS RECEIVED
MEMO NO. q 1- 45j
2nd REVIEW COMMENTS RECEIVED
UTI L.
'Hr P.W.
PARKS
FIRE
*I!' POLICE
PLANS
o
o
o
Ia
o
BOARD MEETING DATE:
BOARD:
LAND DEVELOPMENT SIGNS PLACED AT THE PROPERTY. DATE SENT / SIGNS INSTALLED:
DATE:
CITY COMMISSION: DATE:
DEVELOPMENT ORDER RECEIVED FROM CITY CLERK: 0 DATE:
DEVELOPMENT ORDER SENT TO APPLICANT: 0 DATE:
S:\FORMS\TRACKING LOG FORM
revised 4/25/97
o
o
o
o
o
0,
RETURN DATE: q 118 h1
,
I
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