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ORANGE COUNTY HEALTH DEPARTMENT <br /> 14 <br /> REFERENCE NUMBER MAP REFERENCE <br /> -V <br /> DATE PIN <br /> APPLICANT: OWNEFt. <br /> 741 • <br /> TELEPHONE: <br /> SPECIFICATIONS: LOT SIZE ACREAGE: DESIGNATED WETLAND? YES - <br /> i) L NO - <br /> LOCATION DIRECTIONS: <br /> ;,? ') Q <br /> f <br /> FEE: RECEIPT: SIGNATURE OF OWNER OR AUTHORIZED AGENT: <br /> CONFIRMED BY PLANNER: PLANNER DATE CLERK <br /> DRAWING NqT,-T <br /> -T SCALE <br /> Y EL-n LEVEL Q.49 TEE R Z Q,�-E. <br /> ---------------------- <br /> A�' <br /> 'o1-4 L:T-zl <br /> SEE IMPORTANT INFORMATION ON THE REVERSE SIDE <br />