Appendix I
(City Seal)         CITY OF NEWARK
            DEPARTMENT OF PUBLIC SERVICE
            CITY BUILDING,  40 WEST MAIN STREET
            NEWARK, OHIO 43055 (614) 349-6626
AUDITOR'S TAX INFORMATION FORM FOR LOT SPLITS OR LOT COMBINATIONS
I, the undersigned                          as (  ) the owner, (  ) the owners representative do hereby (  ) authorize (  ) request the Licking County Auditor to (  ) Combine (  ) Split the following:
PARCEL OR LOT NUMBER           NAME OF ADDITION
 
TO BE FURNISHED BY APPLICANT: You MUST submit a tax map from the Licking County Administration Offices with your request for a lot split or combination.
Buildings on parcel(s) or lot(s)                      
Reason for requested change                      
Tax Mailing Address and Phone No.                   
            SIGNED              
                  (Owner's Signature)
            DATE                   
ACTION BY NEWARK CITY PLANNING COMMISSION
   Approved
   Denied                         
                  Planning Director
   Other                        
                  Date
(Ord. 93-62. Passed 10-3-94.)