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<br /> APPLICATIOP,
<br /> TO THE APPLICANT.
<br /> Thr tea, itary pe.snl+ is va a %a
<br /> a 'f, it
<br /> epa ,
<br /> y,
<br /> - a .r, �, - . . -lz� ,r� . ._''W" ' "cr." 11 :o my 4pro;ec,
<br /> it ncuo.- wit Mversity 'A A s„_asc
<br /> Absuptun system information. P-ovine al; infnrmatior, rr,our stet, -n 4!r-e
<br /> -ank. lnformaha. rill in the :ape. t; of e,erg an or :a ex hnc ar,. AV the total gehuns tb be nskW,
<br /> number of tanks and manutaourer s name. Indicate prefa e' site constructed and tank material. Complete
<br /> ter all septic. liftlsiphon chamber and -Wine Taws 0, the system Check experiments' approval only If
<br /> tanks received experimenta; product approval. from DILHR,
<br /> Res,onsibili y statemen' iostaHmg plumber i, W `ll name lice-se number wit appro; ,ate p,_"I>: g.
<br /> UP etc.; aadress and ohcne number Piumber must sign applwadlor form. FIt'. in designer name 'f
<br /> applicable:
<br /> zs' rL-.canon cen'i!ej sc'. t_. K: name cc W� ac's:"e_. a Dhow n, »tom.
<br /> County/Department Use Only,
<br /> -a ,,.,o by c "'tr (; r ., qtl• - 1 b . :r)t,vP
<br /> ! sloe;donor . I " 7., 'Oh " 70
<br /> , 4r _ clu_. e f^ ov ung A' _ ,a; -14 x r onalm - -sh. . -a' -
<br /> r OIG C t-11, of epT'� tar S : o' ,'t, i t`.,' nr t di ig N ,- ! _ as
<br /> stred,-ns and yak S, dJSin O, pun:ou a Gndn op.'s il.r.ibutipL pOX'S Syare ns rep a,W.",'�
<br /> sys".p" r' ; W -. .. th 't , jm_, s- 8 un'.a N f -_ 'evaSn, ref- en.e poirk
<br /> -t- Npewcaws to pixops and cont o ,.. idose volume Wevabon, differences. Wo" loss puma
<br /> per'. ., a cove imp model and puree -mi 'yt. ..:e Q emo. sucho W to >Y' -Yale-, ..
<br /> required by rhe m mty, E) soil test data on a t' 'or
<br /> :iN lii3 sti ilYC.'�c;s SURCHARCE.
<br />
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