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Dot~ 4~15~71 <br /> <br />MARION COUNTY HEALTH DEPT..Sanitation Specifications <br /> m. ~_.~ Number /~ ~ ',~ __ <br /> <br />Permit Issued To:..~'_'.....~. Phillips 363-6833 <br /> <br /> Properly Address ..... ~__zz "7T~"-'7TM <br /> <br /> _~'~:' Gals. <br /> <br />~/'" Width of trench ........ sq. ft.__ <br /> <br /> Issued by; ~~ <br /> <br />Septic tank: Minimum liquid capacity with distribution box <br /> <br /> ed ~'~ Lm <br />Subsurface Disposal Field requir ........ .., ........ ' . fh <br />Lot survey ........... <br />Other requirements: <br /> <br />7/--J/~? <br /> <br /> Record Of Individual Sewage Disposal System <br />To Be Completed .by !pstaller ...~/'~ .__~,~ <br />INSTALLERS NAME...~'--~~'~'hone N~''Ti ~-~""~;;~,ddress ......... _~,j.,~,,,~,~:.~'.~.¢-~::.:~_:_~ <br />Total number: Living units Bedrooms Baths Basement: Yes [] NoL~ <br />Water supply: Public system ............... Individual well <br /> <br />Septic tank: Distance from well <br />Totul hquJd capacity <br /> Diameter <br />Tile disposal field: Distribution box? <br />Length at each lin~___;:~/~9~')' <br />Total length of aH lines <br />Width of trench___ <br />Total square footage <br /> <br /> ..Community ~ystem <br /> __.feet. Material No, of comportments <br /> gal, Inside length B, inside width __ ft. <br />.... ft. Dquid depth ft, <br /> Yes ~ ~No [] Other <br /> /f~?~Z;_ .~,. <br /> ft. Distance from: <br /> ~.ft, Well s, ¢L~i~-' ~'*~'_ ........ fh <br /> ...... ft. Nearest <br /> Lot line: Front [] Side[] ~ear ~ <br /> <br /> Distance between lines ................. ft. ft ........... <br /> *Cj' Fou ndation~,O' ft, ~ <br />Type of filter material,. Gravel: ......... ? , Other Depth beneath tile ~r-..- .inch~?~ <br />Depth of filter material over tile ......... ~.. inches, Depth of tile below original ground surface ,,~"~"...,.~ inches <br /> <br />Sketch of instellation. <br /> <br />Note; Indicate Northerly direction, <br /> Inspection will not be made until completed form is returned to the Health. Dept, <br /> <br />System apparently will ~'"'~ill nat [] <br />Remarks <br /> <br /> (FOR HEALTH DEPT, USE) <br /> <br />function satisfactorily, and is therefore approved L~'-~J~'Sapproved [] <br /> <br />MARION COUN~~ <br /> <br /> <br />