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PHFIL` H 1 IS 4E <br /> ^cls, County F`r'og/Sub E1 em t,./rr <br /> Li <br /> Oo El� 1- /r l I <br /> E .H . (assigned by clerk) <br /> P/S . E . Local Com P . Number Sup/D- st . Location CodeFee Ex. <br /> EU lrnkldDlol i7l Lo 7 <br /> L;L-Lu =1 11 <br /> Previous Comp. NuMaEn Effective claw Other Program Activity <br /> LL] I I I I I <br /> SITE NAME (30 acto(®) <br /> M D o n1 A4 N C J) / r 10 .Z®u G , <br /> SITE Address (no./Pi r/Street/Suffix/Suite) Site City/State/Zi <br /> F_/// IV'- C/4 12 611;zo 61 <br /> PREVIOUS DDA <br /> Billing dame <br /> -1 <br /> Billing Address (Ho/Dir/Street/Suffix/Suite) Bi I lint City/State/Zip <br /> cS' 3® cv� ,err d4_L._/25 I _ ,Ers.� L�/ / �o2 t! <br /> ESI SIZE SATE TELfM 40CH <br /> Cats NSA a <br /> L_LL Sq. Ft.OVYN <br /> Un <br /> En NAME (30 ChW3CW3) . �® _7 / . <br /> CA)A-44LLz> ,� <br /> owNEnAddrtss (No./Dir/Street/Suffix/Suite) - Owner City/State/Zip <br /> ® ° X_ W7 <br /> SPECIAL PROGRAM INFOR,11ATION No.ofService* Sourceof Treatment Population <br /> conncctlons Supply TYServed <br /> Ric. Health Water <br /> ADDITIONAL COMMENTS : -41 <br /> San. Sup. AC SC <br /> Edi 01 15 H g I--] <br />