Laserfiche WebLink
EFILE F <br /> S tr . <br /> AcIK)n County Prog/Sub E1 em C40vum No. I).ary <br /> 161 L2J-2J Eo I <br /> s' <br /> E . H , (assigned by clerk) <br /> P/S . E , Local Comp . Number Su Dist . Location CodeFee- Ex. <br /> 1�j 6-1 Lir ETL i <br /> Previous Comp. wmac-n Effective oate Other Program Activity <br /> 1 IF q <br /> SITE NAME l30 actors' <br /> SITE Address (no:/tai r/Street/Suffix/Suite) Site City/State/Zip <br /> 1 / � • �- <br /> PREVIOUS DDA <br /> 8i l l in �I�me <br /> Billing ,Adriress (Ho/Dir/Street/Suffix/Suite) BiIIin2, City/State/Zip <br /> Q <br /> EST SIZE SITE TELfN :E 40EN <br /> SeatsNrt� <br /> Sq, fit. 7 <br /> units <br /> MNEn NAME loo aCtcrs) . <br /> OWNERAddress (pro./Dir/Street/Suffix/Suite) Owner City/State/Zip <br /> SPECIAL PROGRAM INFORl1ATION No.of Sarvici Source of Treatment Population <br /> Conwtiont Supply Type serval <br /> LRec, 11�eal th_ <br /> �iJa to rED <br /> ADDITIONAL COMMENTS <br /> San. Sup. AC SC <br /> EII 01 151:1 <br /> i <br />