Laserfiche WebLink
DEC-04-97 10:46 AM HUNZICKER ELECTRIC 1 1 209 537 1573 P.05 <br /> RVI 613 Wood Im/93 <br /> E:Y <br /> 1D CORD ID 0 I I 0 <br /> 1� <br /> JA f <br /> AV <br /> 0- Ap <br /> izkILITY NAWBllf.i P TY r J <br /> iITE ADDRESS ✓. � /�E y7 -s°7�'-' <br /> ZIP S-2-4 <br /> ® wuu I�ww■ <br /> T irct--��1/" r- ou BILLING PARTY r <br /> PHONE 01 (!-of/d 3 I• ' <br /> ADDRESS t Cd / es 1� -tle. a-vr rl PNONE R <br /> CITY O STATE <br /> ZIP X,452 4�' <br /> ['A1PN 0 L ticatfon 6 <br /> Otac L tIon <br /> T orAn <br /> SERVICE <br /> ST frl /� : 1ILLINQP TY Y J7,7 <br /> •, Ltd /�,(�-c�' fE?G�YJ�, ec-L4�tu�Gct t <br /> MAILING sS / C13 txG `°I! F <br /> U - r <br /> CITY 1�vL`"`` ATI: - IIP <br /> BILL! A NT: i, the rsf r` rotor of ® ac t that all site or project Ifift <br /> pWgmD howly charges osswfdtGd with this facility or activity will beLbitted to the party Iduntiffed as the BILLING PARTY <br /> an <br /> Pass I ofthis form, <br /> i <br /> t •E rtify that I have r this application, that he rk to performedwilt in •cc a 611th Ott <br /> SAO <br /> StIN TT i <br /> , state F I low. <br /> "'APPLICANT111 SIGNATURE <br /> T; te: Date;- <br /> AUTHORIZATION <br /> ata®IZATt TO RELEAS6 INFORMATION; InNMticn to the above, when llc lo, I, the owwr, qmrator or Agent of folOv of <br /> Ow property Locatedat the above sito s her horits the release of alt results, t i t to or <br /> f t•il•ita rases t inf tion to SM juaulN COUNTY PUBLIC HEALTH SERVIcET ENVIROWNTA1. OWN DIVISION a <br /> oon 86 <br /> ft`is available at the i ti it is i to or r re tatfve. <br /> Nature of Servfoe R at: Sm"ice <br /> coo <br /> AuIWW to <br /> Roployes 0 to - <br /> Rote service lot Further ActionR it : Y J N EL NT <br /> By <br /> Fee Amunt Awmint Pold Date of Payment Paymnt Type Receipt 0 check 8R <br /> ecvd <br /> is , v <br /> e = 11 <br /> 'LOS L <br /> TIN IT cul <br />