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REQUEST FOR FILE INFORMATION <br />LOUDOUN COUNTY DEPARTMENT OF HEALTH <br />1 Harrison Street, SE Local (703) 777 -0234 <br />P.O. Box 7000 Metro 478 -8408 <br />Leesburg, VA 20177 Fax (703) 771 -5023 <br />Date of Request: . 9 / ?— 0 / 0 <br />Property Owner(s) L<E / 7 a <br />Street <br />City <br />Tax Map Number <br />Pin Number <br />&Ae L 4Ai <br />s' i !? L I &a Zip Z <br />C^ ;R, ,J <3,l C I'-L <br />Info Requested By: S <br />Telephone Number C? o'3 ) - !YIVVI 53 jaf~7 <br />Type of Info Needed <br />FOR OFFICE USE <br />Number of Copies X .25 = <br />Staff Time Expended <br />Computer Time <br />X $13.501hr. = <br />X = <br />Total Cost = <br />forms /foia.sht revised 10/15/97 jjs <br />