Laserfiche WebLink
ENVIRONMENTAL HEALTH DIVISION <br /> ACCOUNTING WORKSHEET <br /> UNIT # �� <br /> CONIPUTER/PERMIT # A� f / Copy <br /> S1TUS/FACILITY ADDRESS: <br /> DBA: /l- liAVL <br /> BILLTO: PHONdlKOR)2,7&- 39o( <br /> BILLING ADDRESS: <br /> CITY/STATE: /�ie�S/�/V G/4 ZIP: '757/ ( <br /> PROGRAM: Z TYPE OF SERVICE: ���f� 1e6;,rou/q L- <br /> THE MINIMUM TIME FOR EACH INSPECTION IS ONE (1) HOUR, ANY ADDITIONAL. INSPECTION TIME IS COMPUTED TO THE <br /> NEAREST HALF (1/2) HOUR, INCLUDING TRAVEL TIME. <br /> DATE WEEKDAY WEEKNIGHT HOLIDAYS DESCRIPTION OF WORK REHS NAIME <br /> of 3ANI- 4:30PM-3AA/ <br /> SERVICE 4:30PM WEEKENDS <br /> GGo L C.� G <br /> /,p e( �d:.3p-moi�� Fn, Ew -�E✓F <br /> ��l �: Z.D' g� ri off �.doG-ry E•w_'+". _ <br /> :Lu-q I �JY To E• GC�•T. i� <br /> [' Gl :011-G' I� G/ lFi^+G �wE7v ( <br /> /z 9 Z7 <br /> 3,30 <br /> IIAL4NCE DUE: <br /> MILLING DA'Z'E: <br /> EH 23 074 (Rev 3/22/91) <br />