1981, 03-13 Permit: 80B-4923 Inspect1
IlVSFDCTION RECORD
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DATE
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REMARKS
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APPLICAr' T: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
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LEGAL DESCRIPTION - SEE ATTACHED
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CRAMS OF Inc FROM
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of EXEMPTION
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SEWER
Own.r.nlp
Public °Private IK
USE CODE
hereby certify that 1 have reed end examined this application and have read the "NOT " provisions included
On NORM side, and know the same to be nue and correc, All provisions of laws and olihn:nlc.s governing this
Sgpe 1 work will be complied with whether specified herein ur not The granting 1,1 a ;J., .11,l dues not presume
a authority to violate Or cancel the provisions of any other Data or local law regal n,n C1n1 tructlon or the
mance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION �O :SI -$D SIGNATURE Or APPLICANT Aide_
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
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TOTAL S a.S.3e-
B
PERMIT NUT.6ER--1 41/1
02* *2830
•2830
•28300
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4115f
11-24-80
2 6479.
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