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MOBILEHOME INSTALLATION ACCEPTANCE
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS — 7 COUNTY CENTER DRIVE
OROVILLE, CALIFORNIA — 534-4541
PERMIT NO. -Q
Address or location of mobilehome
Owner's name
Owner's address
Insignia or hud number
Manufacturer's name L,�
Serial number of V.I.N., '-2 "L 1,� L Year of manufacture
(Official Approving Installation) (Date)
'-V'ITH-E MOBILEHOME IS MOVED OR RELOCATED, THE MOBILEHOME INSTALLATION
ACCEPTANCE SHALL BECOME INVALID. THIS FORM SHALL NOT BE USED WHEN THE
MOBIL�EHOME IS INSTALLED ON A FOUNDATION SYSTEM.
513B White - Owner, Yellow - Installer, Pink - D.P.W.