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Get FL Notice of Intent 2003-2024

to Land By Winery Wastewater Treatment and Disposal Systems 1. FACILITY OWNER INFORMATION Owner Name Mailing Address City County Contact Person Owner Type (check one) State Zip Title Individual Corporation Telephone Number Partnership Other: 2. FACILITY SITE AND CONTACT INFORMATION Facility Name Facility Address If no address, nearest cross street City County Contact Person Title 3. LOCATION OF FACILITY Assessor’s Parcel # _____________________ Township/Range/Section T ____ R .

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