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Lot' Block:, Subdlvi~ion: No. Acne: ,~ <br /> <br />...................................................................... t ,~ ) ~ <br /> <br />Scale: <br /> Drawn By: <br />I certify that the above information is accma~ to the best of my knowledge. <br /> <br />MC: 15-60 <br />Rev, 11/91 <br /> <br />PLANNING: <br /> <br />PUBLIC WORKS: ...... <br /> <br />BUILDING iNSPECTION: <br /> <br />FOR OFFICE USE ONLY <br /> <br />Date: ., , <br />Dat~: ....... <br />Date: <br /> <br /> <br />