1981, 03-23 Permit: 81A-2618 InspectINSPECTION RECORD
ADDRESS
DATE
23-e/
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e-/ Xe-/ 7 / ytifr"4.c.".44fe
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SPdjcANE,COU ikdkgfy1,.8' ENT
NormarerreMEIsHiNoToti
APPLICANT COMPLETE NUMBERED SPACES - PPESS HARD TO MAKE 3 COPIES
l'&° t9� d 6idii+air, u31Vt,
LEGAL DESCRIPTION - SEE ATTACHED
x 9r
n�oro'.o.j2i1-4' QLkT rIE DK.
k lal.nA J c , flQc4QAc NG
"251 co1,o,JVrt
2764z-7009
`- 50,8
s17,2+1--
ei,oW
' � X FIOUIII
IJ238 *"44il PALS
npe,.r' I 311a.a
E
MOSE
‘9b
Iia
ZIP
aka
a• °' W a..W.. D M.cH. D n.. arc.
Arm at D I
oa.TEPP„T.
EXEMPTION
7.4-0
FI M '•""^'
a;ALWc arox()
a YYY TT��NN ...000OAS
.num Din Lortlkn lAra
5L(lG
USA COCA
diaries
02• 1700
.1700
.1700E
•000 8
03-20-81
I eEl,wii
.'1
FFF. COLLECTED
enol
I WOW eerily that I han rind andexamined
' MM . am nedto .pol. ne, aaa the 'NOII rrA
luileri
lon minim bd., eento be
,nAllVWeoot governing this
of work will Wemo ed with *h IWO'S heroin
' not Theartn of Cott npt t
n.
.• NpntY I iollate o eat1Me pran n aTei raa oetl la en.l.ni I 01511 tm OF OW
enlorvWtion
SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
RATE OF APPLI.A.IDe _ , nG*AIUHEo..e.,5Ar . �1�..
EaAI. APP.` V LS L _ E.TL /
• coNT. NcO4.*O4 243PP 3
9/.zo a To c.a- q.of.w
Wnn
t�
TOTAL $ 17'
e