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DAte: ~ <br /> <br /> .......... <br /> <br />1. Location of Installation <br /> <br />Com'~ereial fl)S~- DailwSewa~e l~l~w% S <br />$i~ ~atio~, ~ 10~ gal, D~ ~,~ 20-~ <br />Sit* ,gy~t;o~, ~,,~d]. S~ ~,t, ~F 75.~ 20.~9.,,' <br />Standa~ Sy~cm 1o$$ th~ 1~ ~'. ~$F ~45.~ I0 ~ <br />Gray ~W~ Di~] ~u~ 1~,~ ....... <br />Sand ~iltcr ~5.00 10,00 <br />~epa~ T~ach ~5,00 10.00 <br />St=ap $ ppi ...... ~$~ <br />~lc ~at~ag ~cm 350.~ 10.06 <br />........ mm,m L <br />~c~o ga~. Ds~,<,,~oo~ gal ~F ...................... ~00,~ .00 <br />(F,~ ~ddiiional 5~ ~al. ~F 2~ ,00 <br />Rcp~lr~ Minor ~$.~ 10~ , <br />¢~n~mcti9n Pe~it R~I (FIAM ViSit} I S0,O0 'I0~ <br />Autbo~ti~ ~otlee ~ld V~,i~) 150,00 10.00 <br /> Authofiz~ ,Notlcc ~o HeM Vial), 85.06 I0,~ <br /> A~nual ~On ofAl/cm~ve ~m 1~,00 10.00 <br /> XnnuaL~v,lu~o~ of~c S~m ~.00 ......... ~,~*~ <br /> <br />(Ma~i£Appli~blA Io thla Appli~iou) <br /> ~t'~$1 IIoles m Dui; <br /> will call ~hcn Tcs( Ho]~;~ D~{ <br /> <br />I agr~ to n~ll geco~hlg o file submitted plans and ~e¢ fiu~'l~M,'~e laws <br /> <br />NAME OF APPLICANT (please_print): <br /> <br />MC 1S-SI REV 2/93 <br /> <br /> <br />