865 Bucknam Ave.
,., \
L ~ \, ('ll)
INTER- DEP ARTJ'.'IENTAL r-TI::;UOR'!\1:1DUl''l
TO: Building Department
FROH~ Puhlic T'7orks Department
The requirements of the Public T:orks Department have
been satisfied for the follm"ling development::
APPLIC.i'\NT
S~j-\-- ~
BUILDIHG ADDRESS__ 8 (.9 ~
B iJ.--C"'- V\.~~ vA
CO~~Y ASSESSOR'S
P lU::'CEIJ NUI'1DER
4-0 s - \ ~ -- \ \ \
II S II APPROVAL
NUMBER
N.~
PUBLIC vJOrmS
]:"" ILE HUNBEll
wA
Lvi. C'I)
WILL Ii'\.H G" lVREN,
DIRECTOR OF P - LIC y,10RICS
By
L~
Date \'2> S<;L~ IS
(Yk \ ~ ;J ~{.J 12'.- tQ .
PECEIPT
CITY OF CAMPBELL
CAMPBELL, CALIFORNIA
NAME
ADDRESS
FORK
!1v~~i~
~PJ--/~ -// ,- 17t1~
RE.VENUE ACCOUNT NO.
3 c,J---
/l-
FUND NUMBER
~ CHECK
?d- ~/3
o MONEY ORDER 0 CASH
DATE AMOUNT
THIS RECEIPT
MUST BE MACHINE
VALIDATED AND
SIGNED BELOW.
SEP 19-75 008 -** * 170.00
SEP 19-75 6S ooaA ***170.00
2521
BY
<e!s
CITIZEN COPY