Laserfiche WebLink
MA5TOHLE HECORD INFORMATION F& <br /> /RC1 Kart Counl y Pr <br /> e, Wa+n Computes Na <br /> ro <br /> LEJ <br /> (assigned by clerk) <br /> Local Come. No. Sup/Dist. Loca("iCode Feu AimiunflorCuxk 'Fee Ex. <br /> 111-1!�Llv ERA L11=1 0 <br /> Previous Camp. NUMBER Effective pale Other Program Activity <br /> Lo h Lo I g � � I <br /> SITE NAME (30 chwaclera) <br /> ATE Address (no Pi r/Stree t/Suffi x/Sui te) Site City/State/Zi <br /> PREVIOUS DESA <br /> Billinq fume <br /> Bi l i i ng .Address (No/Dir/Street/Suffix/Suite) Bi l 1 in _ Cit /State/Zi <br /> Program Elefnent ES1 titZC SITE TELEP"ONE NUMKH <br /> # Seats N<A <br /> lid= Sq. Ft. <br /> # Units <br /> OWNERNAME (30 characters) <br /> II . <br /> OWNER Address (No ./Dir/Street/Suffix/Suite) Owner City/State/Zip <br /> SPECIAL PROGRAM I �ORIIATION <br /> Rec. Hea] th <br /> No, of Service Source of Treatment <br /> Program Element CQnneCtlonsSupPIY Type Population <br /> Served <br /> Water 4 6 m <br /> San. Sup ., AC SC <br />