309, Construct tennis court pool ho, Resolutions & Approval Conditions•
For Recorder's use
as 415509 •
RECORDING REQUESTED BY AND MAIL TO:
CITY OF ROLLING HILLS
2 PORTUGUESE BEND ROAD
ROLLING HILLS, CA 90274
Please record this form with
return to:
I FEE $7
the -Registrar-Recorder's. Office
City of Rolling Hills
2 Portuguese Bend Road
Rolling Hills, CA 90274
(The Registrar -Recorder's Office requires
before recordation.)
STATE OF CALIFORNIA )
COUNTY OF LOS ANGELES )
ss
that the
Acceptance Form
CONDITIONAL USE PERMIT CASE NO:
VARIANCE CASE NO.
I (We) the undersigned state:
I am (We are) 'the owner(s). of the real property described
R-01-1-1 n .c- , » 1 , Llit .
This property is the subject of the above numbered cases.
I am (We are) aware of, and accept, all the stated conditions in said
Conditional Use Permit Case No. 309
Variance Case No.
and
form be notarized
309
as follows:
I (We) certify (or declare) under the penalty. of perjury that the
foregoing is true" and correct:'
(Where the owner :and applicant -are
Applicant Name
RECORDED IN OFFICIAL RECORDS
RECORDER'S OFFICE
LOS ANGELES COUNTY
CALIFORNIA
21 MIN. 11 A.M. MAY 30 1985
P.AsT.
not the same, both must sign.)
Type or print
a g
Address MD101 NJ. C 'ltL EY)A
ity, State . 10561
Signa
Address
City, State
Signature
This signature must
be acknowledged by a
notary public. Attach
appropriate acknowledgement.
tt- k
Owner Name��--
61 Po c*u r'e.s'e.__. ' e_s�tl QO.
\\kNC\ k-\-\s, Ocx. q0a .
1
GENERAL ACKNOWLEDGMENT
State of
County of
California
Los Angeles
SS.
85 605509
OFFICIAL SEAL
CHERI L. EVANS
NOTARY PUBLIC - CALIFORNIA i;
__ LOS ANGELES COUNTY IS
�' My Commission Expires June 27, 1986 j
.
On this the 30 day of Apri 1
Cheri L. Evans
the undersigned Notary Public, personally appeared
James Bird & Elizabeth Storm
personally known to me
❑ proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) �S
within instrument, and acknowledged that 1
WITNESS my hand and official seal.
Notary's Signature
19 85, before me,
:uascribed to the
executed it.
NO. 201
7110 122
NATIONAL NOTARY ASSOCIATION • 23012 Ventura Blvd. • P.O. Box 4625 • Woodland Hills, CA 91364