Laserfiche WebLink
Date run 7/27/2015 9:14:01AN SA4AQUIN COUNTY ENVIRONMENTAL 10TH DEPARTMENT Report#5021 <br /> Run by Paget <br /> Facility Information as of 7/27/2015 <br /> Record Selection Criteria: Fadlity,ID FA0003847 <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,andor project speck,PHSIEHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in eocordance with all applicable Ordinance Codes ander Standards and State anclor <br /> Federal Laws. <br /> APPLICANTS SIGNATURE: Date <br /> Program Records to be TRANSFERED: "$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> EHD Staff: Date / / Account out: Date <br /> COMMENTS: <br /> Invoice#: <br />