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LOT NO. : 2 ADDRESS � 9-lit d
OWNERS NAME: T- 0. aye-4/f 14O: "P 17
SEWAGE PERMIT NO. : NEW: REPAIR: %
DATE ISSUED:_y/i f Ys= DATE INSTALLED: 99/s/2
INSTALLERS NAME : K . P. t e c_t.)e7 C'o4'c
INSTALLATION OF: //61,j�,vi P eox CLA,44k7-5
WATER TABLE : 7" FINAL INSPECTION BY;' \
DRAWING OF INSTALLATION ON REVERSE SIDE: j