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PROGRAM ELEMENT 2221 <br /> AREA DATE <br /> DBA n Pn 1 ,nrBY,�eY� (� PHONE <br /> ADDRESS (S (11 I OSU CITY 1 a <br /> OPERATOR PHONE <br /> OWNER PHONE <br /> ADDRESS <br /> BILLING ADDRESS <br /> CONTACT PHONE <br /> ADDRESS <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR SANITARY DISTRICT <br /> FACILITY TYPE SEPTIC WELL <br /> TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 <br /> TANK $ TANK # TANK # TANK # <br /> STATE ID STATE ID STATE ID STATE ID <br /> PRODUCT PRODUCT PRODUCT PRODUCT <br /> SIZE SIZE SIZE SIZE <br /> PIPING PIPING PIPING PIPING <br /> MONITOR MONITOR MONITOR MONITOR <br /> EH 23 030 8/89 <br />