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MARION COUNTY HEALTH EFT':-Sanitation Specifications <br /> <br />permi~ Iesued To' , E~,~e Kel.l.y. 364-2726 Probity Addre~,s 5785 Shaw Hwy. SE, <br /> <br /> ~ECORD OF iNDIViDUAL S~AGE DISPOSAL SYSTEM <br /> <br /> Total liquid Cal:~Ucily .,,/,~..~,..~,, .......... gals. <br />Tile disposal field: <br /> <br /> L~nvlh of ac, ch lt~e ......... /.ff...O. ....................... £.~.~ ................. <br /> <br /> Total lenqth of all lines .......... ~. ............ it, <br /> <br /> Width of trench ....................... ~......~/~ .......................... it. <br /> Distance between lines .................... ~,.,.,O, ................... it <br /> <br />CLF.~AN NO, 2 <br /> <br /> Depth of fiIe below ori~in~i ~mund su~[~ce .......... ~...~... .......... inches. <br /> <br />Re~ ~ ............................ fl, <br /> <br /> Note; Indicate Northerly direction, <br /> Inspection will not be made until ~mpleted form ie returned to Health De~t. <br />DATI~ ,.,..~.,,. .................. ,.. .~. ., .. .. ~ .... Siqn~ture of lnst~lle~~,.,,,,.~../f"'ff~.,~?.~,. <br /> <br /> (FOR I~ALTH D~PT. <br />System apparently will ~ will not [] tunction saflstactorily, and is therelore approved ~ Di.~pl:~oved [] <br />Roma~k~ ............................................................................................................................................................................................................................................................ <br /> <br />Date <br /> <br />Copy (1) MCIiD files <br /> (2) Yellow -- RefeMnce <br /> (31 Plak -- I.~st~lle~ <br />~H--43 11/71 <br /> <br />D~PARI'MZI~ <br /> <br /> <br />