1981, 02-03 Permit: 81A-0377 InspectINSPECTION RECORD
ADDIS' 1
' DATE REMARKS
- 3-6" l ehd ragzer a -P/{2 a pra �Ca
rhizi ,t r ec,. _ era s
3-1/ 4,9 ic.r„ia6 - 4t4 n7' r -ek Sta4
po4C/I
9
te-
//a?/8/
$
--rllTFS eIF•^=?:�lill+'7Y. '.:'
NT
Deme RSON r aaxc, wnsx!POLON dein° . MOM aeaaPM
APPLICANT: COMPLETE NUMBERED SPACES -P
t N
y-15. 1 1059sSi or.> R •pre Aopt ca91
tYPTIAR
3. I&PPM 'Ro-n4
'
S. I0I8(e. .f64REr bA
l -stainer
sp,K�:01RLyCiNwMM6n
PHONE
c1iB-3N(1
lN�pUI.N�.R
wenn
497oc
PHONE •
ZIP
RESS HARD TO MAKE 3 COPIES
LEGAL DESCRIPTION - SEE ATTACHED
00.54-1805
Root SY •-Isomn^ I. 10' Iwm 10
7;, X 145 i014. -T. F.rnIW
PHONE
ZIP
V•
lova
an. Si",
Imp_
.rApo DatumI N,I;0� 2:75. in *- 2
elEXEMPTION
GNN..0P Nn PROM
TO
'Piga 490
r Paden
$76 wo.AIN
GT'l'....e.,„;.”rWY o AWN
CIRR-
DME 0
e%a Otue 0M.Cw N w
OD
PUMP Pp I
t
1,herstry rnro that I n and examined m,uo°ncenen end neve read the NOTICE 01 lncluaen
on . Ode, and know to. same to be true and opium NI n,mmom of end mnvunces ym.rnme this
m ylvel work
to violate kneel N. provisons'of env other not
To ;local flaw mulati e=does
struceon,OF the
perlormence of comrvmon, EEE REVERSE SIDE FOR REQUIRED INSPECTION
'DATE OF APPLICATION. fZ 3o -&O SIGNATURE oFAPPLICANT ")2tV"l.
WAT, IMxPPnc
PARK rOP r.d
USE CODE
-1mc1E, AM,RDVALSL,T SPECIAL CONDITION, icao,e e. ?c}
mem.
• y,
"PPP
rgt
�• �f
M Nn•nea
M,41)E- ITca RMt -cnd-
' fia\ Aa.D C
sssaceuscnO
e 1
B OOM; 4.3mito
N unS,M
Nn Cock
RMobile
Mm.
011e IbMllvl
RI
02.• "•349.00,
•34900p
• 3a9009
•000'8
376el dW
ass
Qt-tz-e;l ,,w
6479 1j14
!r,