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101-0°3-7 3 I— !' cGt <br /> -. SITE PLAN MUST SHOW ALL PROPERTY LINES AND DIMEN' ' IECIEVE --• <br /> • M Drawn to Scale: 1 square= /0 - Feet Not Drawn to Scale: Total.'c _ <br /> Js. <br /> - -M®Y 21.2019 �. <br /> yr- J•e 'ers/Prk-/I'Iar;D6ti ,eoa �SZ4 �,aR[ON COUNTY <br /> • — • <br /> -- - • BUIL ING INSPECTION <br /> ▪ ' <br /> • •o oi <br /> !eV • • • •. <br /> d • <br /> ▪ QSS • � 0I �/ �Far To P . h {� / .I <br /> 4-2-F 6452 1P 106 . („1 y / <br /> / <br /> ! -. lit . <br /> , <br /> .EK-/v, , x Sly' 5 <br /> ' \ •' Mid. /!O134 u +� 1'1' <br /> i -\\ __ <br /> : : i -: .8.511:,...s57ibsige: . ‘31G. 47-it- i . . - Zi.: g <br /> - <br /> �▪ • ' 4''Se o-F'F�rr-,Y� r,e(d . <br /> Q . <br /> I certify that the above information is accurate to the best of my knowledge. I AM THE [X]Owner [ ]Authorized Agent <br /> Name(please print): w // E. In cG;1/ My telephone number is: (.5-03) 5/0 - 30ZCo <br /> Applicant Signature:-&i�(fa E �� .o-- - - Date: ....//.2 D/2D/p <br /> Applicant's Mailing Address: /5333 P/etzer l'j. 5 F City. 7 crn er Zip: 973 52.. <br /> FOR OFFICE USE ONLY <br /> PLANNING: Date: <br /> PUBLIC WORKS: <br /> BUILDING INSPECTION(Acceptable for Planning requirements only) Date: <br /> Page 4 of 5 <br /> A-33D <br /> Rev.05/2011,09/2012 <br />