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,a <br /> SITE PLAN MUST SHOW ALL PROPERTY LINES AND DIMENSIONS <br /> ❑ Drawn to Scale: 1 square= _ Feet Not Drawn to Scale:Total Acres <br /> \\\PW-- <br /> OP <br /> • • • . . . . . . . . W°. • • <br /> 9.„ . . . . . . . . . . . . . . <br /> I certify that the above information is accurate to the best of my knowledge. I AM THE [ ]Owner [ ]Authorized Agent <br /> Name(please print): Mike(Mader My telephone number is:503-703-9066 <br /> Applicant Signature: M i`1 — 1U A v- Date: 6-9-2023 <br /> Applicant's Mailing Address:mmader@gkmachine.com City: Donald Zip: 97020 <br /> FOR OFFICE USE ONLY <br /> PLANNING: Date: <br /> PUBLIC WORKS: <br /> BUILDING INSPECTION(Acceptable for Planning requirements only) Date: <br /> A-33D Rev.05/2011,09/2012,2/4/2020 <br /> Page 4 of 5 <br />