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A T ION �rc SEWAGE PERMIT NO.
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INS A LER'S NAME i ADDRESS
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DATE PERMIT. ISSUED
DATE COMPLIANCE ISSUED
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SEPTIC TANK CAPACITY /660
LEACHING FACILITY:(type) PJ'y (size) J607
NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATER
BUILDER OR OWNER V:rce-a-&r• e'r
DATE PERMIT ISSUED: /®
DATE COMPLIANCE ISSUED: //•
VARIANCE GRANTED: Yes No
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