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ADDRESS� L/� J / S � �r ® CITY �OV1Y 11 V a 1 <br /> TYPE PREMISE Log4le �A TENANT PHONE <br /> OWNER Vele? SGS ADDRESS 5 CITY PHONE <br /> Other Special Info. <br /> Plot Plan on Back YES NO <br /> Recorded <br /> ?ATE AC=TY ACTION b <br /> d <br /> -30 -231 <br /> Y- <br /> EH 00 18 Rev. -11/75 11775 r3M <br />