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ORANGE COUNTY HEALTH DEPARTMENT <br /> 51 <br /> REFERENCE NUMBER ! � /L � PIN NEAP REFERENCE• <br /> a ` l <br /> TELEPHONE: <br /> S IRCATIQNS_ L n _ - LOT SIZE l ACaF�rEQ lL� //J TED YVEFLAND7 <br /> //vf C��, (►J°Il�'c!/-' `Fl• 7 / YES <br /> NO <br /> LO ON/01RECTIONS: <br /> FEE: RECEIPT: SI NATURE OF OWNER!/ AUTHORIZED AGENT: <br /> '70 Da�9.s <br /> CONFIRMED BY PLANNER: PLANNER DATE CLERK <br /> SEE IMPORTANT INFORMATION ON THE REVERSE SIDE <br />