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• <br /> 10 <br /> ' ........ r <br /> 0 _____ <br /> 0 ' <br /> _______--------- <br /> �� <br /> __________ _ <br /> . _. <br /> A7L---i, <br /> A/0 ,, <br /> ___.•. <br /> ............_ <br /> (0,. <br /> - . <br /> / 9,7,6, zt. i w_ do i . <br /> 2. Iv-2-eP 1 s5 , <br /> .�_ ;fir, , v9 s A _ <br /> 5 • --e ,..5-6°/fly 1 I <br /> PD <br /> Note: The application cannot be considered for filing until all of the above questions are answered and he fee p:id. <br /> Do not write in space below—FOR DEPARTMENT USE ONLY <br /> Date of Application c)--l 3- 7,c- Fee Paid $/' ' <br /> Permit Issued/Rejected (date) �3^ 7,r Permit Number_23 9 Y <br /> Sanitarian (name) ;1 <br /> Form 2 5-18-70 DCEHD Revised 1123-7_0___ <br />