1996, 01-26 Permit App: 95001409 ExtensionJAN -23-96 TUE 16:06 KINNEY—MATTESON
5099215560
P. 02
TntS FORM IS FQR DEPtUFFMENT USI* ONLY
REQUEST FOR (6 MONTH) EXTENSION OF PERMIT
THE S.STEP PROCESS
1VR NttliT 10 PILL OLT 11113 FORM UPON RRCRIPT 014 :mutat POR AN UKTRNSION.
STE? 1:
DATE REQUEST RECEIVED: INSPECTOR DISTRICT:
REQUESTED DY: Sue Dam% 4 fnne.c.,t PHONE p:C1aA - StS 1
ADDRESS: -WXj5 N Larck,et (,0K lu A -
PROJECT NO: CI5-OO14Oci • P;o 1 qa 2S OAT
PERMIT USE: (3 t) — Di" I6 6-dicv'ds, 10 A `l°to 1
REASON FOR REQUEST: QlLaQ_L ['Oa QA1'Lk4_+Qct -need milk)
STEP 2: (1£ INSPECTOR RECEIVED DIRECTLY FROM APPLICANT- 3XJP TO 37Q J)
FORWARDED TO: /2.l
Codes Administrator
DATE: • //25/96
STEP 3: lea
GIVEN FOR CONSIDERATION TO:
tC Inspector
ENTERED :NOW APPROVED EXTENSION IN HANDHELD ON:
DATE: //2 }/9%
IF NOT APPROVED. REASON FOR DENIAL:
STEP 4:
RETURNED POR REVIEW TO:�/
Codes Administrator
DATE: .,//Zs�ilo
STEP 5t
SENT FOR LETTER TO: DATE:
Office Assistant
CONFIRMATION LETTER SENT ON :
EXPIRATION DATE:
ORIGINAL:
NEW:
WHEN STEPS 1-5 ARE COMPLETE,
• THIS FORM & A COPY OF THE CONFIRMATION LETTER
NEEDS TO BEBE PLACED IN THE ADDRESS FILE.
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