MUST BE COMPLTED BY A TITLE COMPANY, LICENSED ENGINEER OR SURVEYOR, OR AN ATTORNEY ACCORDING TO THE DOUGLAS COUNTY ASSESSOR'S RECORDS FOR ZONING AND CONDITIONAL USE APPLICATIONS

CERTIFICATION

I,___________________________________________, hereby certify that the following is a complete list

of property owners within 300 feet (excluding streets and alleys) of the proposed site of the application

located at (legal description)__________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

___________________________________
SIGNATURE
___________________________________
LICENSE #

----------LEGAL DESCIPTION -----------------------------OWNER NAME & MAILING ADDRESS

   
   
   
   
   
   
   

**** USE ADDITIONAL SHEETS IF NECESSARY ****





















**** USE ADDTIONAL SHEETS IF NECESSARY ****