Laserfiche WebLink
Nt4-S I L4LALL HLGOHU IN)UNMAIION FUI-(P <br /> SWEEPS40 <br /> c4xnI <br /> U^ i r P r o g/Sub E l e m C0nVkAk4 fio.10101 <br /> 3 (moi •ee `"."r„—+ <br /> E .N . (assigned by clerk) <br /> P/S . E . Loc 1 Corn . Number Su is <br /> location CodeFee Ex. <br /> �J I V 0 <br /> I <br />_ Previous Comp. NumoER Effective wt*F I Other Program Activity <br /> 9 _ y <br /> (! L-LLLI-i I <br /> STTE NAME (00 cfmaciva) <br /> 1 + 'T <br /> r <br /> S+TE AdGtes�(.no�_i_c/�tceer�Suff.ix/Susie.) ctie_Li�y/SL�te�Z.i. _ <br /> r o <br /> i PREVIOUS DDA <br /> Billing iIAme <br /> I <br /> dillin9 Address (No/Dir/Street/Suffix/Suite) Bill inE Cit /State/Zi <br /> EST S+IE SATE TEUEP"OHE KiwaEN <br /> � <br /> eats a w <br /> Sq. Ft. <br /> i / Un{ts <br /> i <br /> OWNER NAME (30 Uwacterar . <br /> OWNER Address (140./Dir/Ctreet/Suffix/Suite) Owner City/State/Zi p <br /> SPECIAL PROGRAM 1HFORMATION No.of SarvIc* sowce of Treatment Population <br /> Connections supply Type Served <br /> Neal th [Water D <br /> ADDM ONAL COMMENTS : <br /> San. Sup. AC S <br /> �� <br />