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4.3 SR 12-04-2023
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4.3 SR 12-04-2023
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12/1/2023 1:05:08 PM
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11/30/2023 4:06:16 PM
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SR
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12/4/2023
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Owners Release to Damage or Burn Structure <br />Having agreed with the building official, L I rc Vcmmmmmmmwwwww City <br />or County of- Skef`urh that a structure owned by <br />, <br />Lp <br />1 , " , , , - )i�_C z'- D S <br />S w_ and located at the following: <br />''Owner <br />County: <br />Township: <br />Fire Number: <br />Nearest Cross Road: <br />is under condemnation or unfit for human habitation and is beyond rehabilitation. I <br />further agree that the structure should be used by the fire service for training as they <br />see fit. In order that demolition may be accomplished, I give my consent to the <br />City/Township of E //t /� - v-! <br />structure, by burning or other means. <br />Owne <br />Owner <br />A entfnructors Representative <br />.._..... .......�. <br />use or demolish the said <br />�.M <br />IV f � � �.. <br />Date <br />Date <br />Date <br />4 <br />
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