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03=OO1Ifl <br /> SITE PLAN MUST SHOW ALL IROPERTY LINES AND DIMENSIONS <br /> O Drawn to Scale: 1 square= V,S' Feet Not Drawn to Scale:Total Acres y p,3 <br /> e .Jar' A • • <br /> • 1• <br /> • <br /> • <br /> •', <br /> 1 A <br /> 11* <br /> . . . . > ' <br /> _ aa � ZSo <br /> ,. i) . . ri .00_,___...r90.1 . <br /> • <br /> et <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): T)0.r'r'y') l�' t S..--Oh My telephone number is:( 503) 5SI —1 R 3 toApplicant Signature: A'Applicant Date: g ,VZ3 <br /> Applicant's Mailing Address: //689 A-iv. ,an Lh City: liJ b bard Zip: 270 <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 /> ME)WED <br /> Page 4ofs <br />