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Block:__ Subdivision: <br /> <br />i <br /> <br /> ...... [~...~. <br /> <br />Scalc: /'~=/~' '~ <br /> Drawn By: ,t~;z~ ,~,~,'~"7^' <br />I ~ai~ ~at ~e ~ve ~fo~on is a~ to ~e ~st of my ~owl~ge, <br />applic~t ~l~ ~t) ~ ~/~', Phone: 4~Y ~/~7~'. <br />Applicat's Signa~e: ~ Dam: ~ ¢ <br /> <br /> PLANNING: __ <br /> PUBLIC WORKS: <br /> <br />MC: 15-60 BUILDING INSPECTION: <br /> <br />FOR OFFICE USE ONLY <br /> <br />Date: <br /> <br /> <br />