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/ �,�-,7 <br /> PROGRAM DATE <br /> DBA LA-YV ue,(.. L AREA <br /> ADDRESS -4-(,3B ,4 LA ?4CY- JM CIM CALkvy-\ <br /> OPERATOR PHONE <br /> ADDRESS CITY <br /> OWNER PHONE <br /> ADDRESS CITY <br /> CONTACT PHONE <br /> APN LOT SIZE SHORT TERM <br /> APCD PERMIT SEPTIC WELL <br /> WATER PURVEYOR SANITARY DISTRICT <br /> TANK # TANK # TANK # TANK # <br /> STATE ID# STATE ID# STATE ID # STATE ID# <br /> PRODUCT PRODUCT PRODUCT PRODUCT <br /> SIZE O SIZE SIZE SIZE <br /> PIPING PIPING PIPING PIPING <br /> MONITOR MONITOR MONITOR MONITOR <br />