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®o( <br />• ) <br />EM <br />Detailed description of builds <br />Detailed use of building, <br />Estimated Solid wants generated ennuallyl Pounds/Tone. <br />Square footage of building, <br />no you presently have a franchised hauler Collecting your Solid waste, yEg� No� <br />If yes, please give the came of the hauler <br />Number of Collectione per vesk, <br />If a container is used, plesee indicate the etre, l.e. g yd, s yd., <br />Petition No. <br />pita .,,f`' I 'y� Sj- 'y', Please place a check beside one or mote of the following types of solid raece, <br />6 i <br />®Il1 l� Iia Yud 7[Lmainga Cons t[uctlon/Damol lclon L ',� II <br />'% a'LSy'i4;£ <br />Ctt[ue � Animate <br />'Yhs'?yM1R• Mixed v Hazardous Materiels ,t ! <br />Tired Tree Stumps, logo, brush <br />f�.!IvfiJ('i Burnable Sewage i <br />1 <br />Date issued a Certificate Of Occupancy _/ / Nunlc 1palicy which Lenued C.O., <br />rhr <br />t/ 1 ,ya ly .., s IN trte property rented or leased In the property coded agricul GuraL YES No jF <br />yr1nt! '•4` <br />-3� Is the building vacant+ YES NO Type of Agricultural ueei <br />II Vacantt how long? Dace of change In cenenc+ <br />d 1.+ ` Total acreage, pate of change in Dori _/_/_ , <br />si q'y <br />New use code, I ; <br />{: 'fi4. <br />e. <br />17 <br />I t <br />J �� rShl rix' SECTION IV <br />/ ku <br />I,Y qqtl ' <br />i l XI.1, <br />IF iTlj,�, .� 00 you dispose of ha eerdous waste as dei lned In Resolution e7677 If yen describe In detail[r;ii <br />r. 1 <br />Iry j' ��-, i <br />Y +'it �it <br />Lf <br />I am willing Go Submit any additional information pertinent Co Coln petition; YC9_ H0� <br />)/E Have you discussed this assessment with the Solid Waste Disposal Diote LCt Menage[ prior to Illing this petition? , <br />t w4 ;; YL9_ No <br />i :.} '. _- II •YO•, was a conference requested? YL9_ NO Date of coni s[enre, <br />1 �I LP jj I <br />Petitioner j <br />State of florlde <br />11 t COVOCY OI Indlno River <br />+,tl � yq•1 0 •( 1, <br />The foregoing instrument vee acknowledged before me chin day of 199 by f <br />•M11.11': who is personally known to me or produced as identification. i �",-' <br />Z} <br />A <br />1 ro +f°vl' <br />Notary Public <br />.�P. <br />l <br />+a`?jl* - <br />F <br />RECEIPT " <br />I, hereby certify that the foregoing petition Go the Solid Waste Disposal District Adlustment Board wan filed with the . <br />[II '�il+ir+�t•lr �; undersigned an the clerk of the governing body of this County on the day of <br />k l nf.a..>, fi' v._ <br />�+ �� � hrIA. M., P.M.1. and CM signing and delivery of a copy by me to the peel [loner conecicucea a [eeelpc 0 the Same. <br />11 r{ x i tt <br />iTYLii�- <br />S I, further certify that a copy of the foregoing paticlan wee furnished by me to the Solid weoce Disposal Dleccicc Meneya[ of <br />aL i <br />this County on the day of 19 '• <br />rr <br />tl <br />- <br />I v k v tr'., i <br />i. <br />I trilZlt`741y -..i. County Clark I i F✓ <br />41, <br />-is- <br />