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Tb be submitted with applicatio~ for <br />builclLpg permit or mobile hc~e place- <br /> <br />New Com~truction , Repair <br /> <br />Installation will serve: House ~ ~,oblle ~ ~ iie ~ turk <br /> <br />Water Supply: mmltc ~ ca~muuity ~ private~ ~ C~rba&-e Disposal? <br /> <br />1. Proposed Sub.murface ~e Disposal SyStem Plot Plan <br />2. Plaguing' Eva/uation --- Bu//di~g Permit <br /> <br />3. r~iiding plans <br /> <br />to the best of m~ know/ledge and belief. <br />~ermit No. <br /> <br />I hereby certify that the information ccmtained in this application is true and correct <br /> <br /> <br />