Laserfiche WebLink
frIAjj0 1 IL.L rtLt uhu INtUtiMAJ SUN 10M <br /> +tiCtron Counly (Twain Computor No. <br /> (assigned by clerk) <br /> Local Come. No. Sup/Dist. l_ocal,pnCodo Fuu Arnaunt/or Qxks Fee Ex. <br /> xl LOA <br /> Previous Comp. NUMDER Effective nate Other Program Activity <br /> I ILE I I T-F� <br /> SITE NAME (30 characlere) <br /> SITEAddress (no./[sir/Street/Suffix/Suitel Site City/State/Zi <br /> PREVIOUS DBA <br /> Billing Name <br /> Billing Address (No/air/Street/Suffix/Suite) Billing- City/State/Zip <br /> Rrogram Elernenl EST SIZE U1 r SITE TELEPHONE NUMBER <br /> # Seats NX A <br /> Sq. Ft. H- I <br /> # Un l' <br /> OWNER NAME(30 characters) , <br /> OWNEAAddress (No ./Dir/Street/Suffix/Suite) Owner City/State/Zip <br /> L-- — I <br /> SPECIAL PROGRAM IRFORMATION <br /> Rec. Health <br /> No. of Service Source of Treatment Population <br /> Program Element Connectlons Supply Type <br /> Pe Served <br /> Water ]E= <br /> = = IT I <br /> San. Sup. AC SC <br />