Schurig, Edward Garage Sade Permit
� Application
r
Return to: Town Clerk
Town of Wappinger
20 Middlebush Rd.
Wappingers Falls,NY 12590
Nan}e: .L / R
—(Last) first) )
Address: 'LAI
( treet A ress)
Wappin e�alls,NY 12590
(City) (ST) (Zip)
Phone: (990 of6;7— �?-
Address of Sale:
(If different from above) treet Address)
WapI�inaers Falls,NY 12590
(City) (51) (zip)
Date of Sale: Q/47 / 7 From: r 60 (am/pm) until :, (am/pm)
ay ne (Timebegin) (Time EEI)
From: ! '° (am/pm) until a (am/pm)
ay I WO) (TimeBegin) (Time e En3) Y
From: �� (ann/prn) until &I'` &(am/pm)
ay I hree.) lime egin)
Sign: _ Date: ' -
------------------------------------------------
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni ❑
Grace Robinson 11
Date Received: / 1 1fllECVV LTJ
Serial #;
MAY 2 2 2017
s TOWN OF WAPPINGER
TOWN CLERK