1981, 01-07 Permit: 80B-4320 Inspect1.4/1/ So ` ApPLICATIQNPERMITF
OKANFbOONT1Y tTILOING.CDDE TMENT
APPLICANT COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
LEGAL DESCRIPTION — SEE ATTACHED
a I 41 �M1tP,FffPJcop ooh )7-0
a =tr.? J. MUM -Lc) rn-0616
ely.4 Fitg. riaa
ON b
ino5
PHONE
.aa[•.. .s Oas41- 4x4 ! 05
5. 100' of 1J. not or 6.13 of
-frac -r i
a° lEnnn
,t 35 I,.• t 2-7
aµ•100 Tc 13a—
�wio ��coMrv1.
PIP
t30
Dy., DN.
PHONE
CHANGE OF uto•ROM
TO
o�:
(3S-
'. TRIC
o.Lo °.[.r. D.[[.. d.1.1
DENCRIN
WNL°"- "nN FOURCC ONs E�°)
A 1° WORK
{DOJ
I n.rebV Ally that I Lor rill a muted J OpPrOe and nav u,J Om NV II 1111.1.1
ee,0e. and know etlle a to be and MINIM rifrll ylµ of LIN int ii ee governing this
O'P.e01 worin µIll be ompllea amp
wnm venum fhetMi
o en. authority ,limn al m pwauo ol. o, local b y,L, t oonnron,cn or the
Performance of[ nfitu[Oon..SEE REVERSE
510E FOR REOIIIPEDIINSPECTIONS
o \ (]
w f. - I — Ro vcxn U
AE 0P PSPCANT
M
®E•..�O. 001 a`N011. ELro O M Iikit.pry, cul ire°Jf z0.
y4.
6(.
eigp.s 01,
Lopw nowt
8oµ°.,I `"L...r....1 t
....1111. INo.Stw1_ NERtem.1..l
CERTIFICATE
of EXEMPTION
Lawlor, Myst
sEwER
sgrjL
win o:n.n.
USE CODE
FEESCOLLLECTEO
• r
P ▪ ueee
TOTAL S 5O'
bdBM5EF3i
07. •500�I'F
• 500 I
• 500 G
•000
A
4310p
12-01'•80
INSPECTION RECORD
ADDRSS
DATE REMARKS
/ / / j
F.?—RI fI/C 11 ��drieeh:,fet('// /1�, sl'/i! r nn ana�o it
2.4
/[2-/s-,cl
)