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MARION COUNTY HEALTH DEPT.-Sanitation Specifications Date ~--R~--71 M~BTLE 'HO~ Number Perrni~ Issued To Do~ald E., Kinq r - ~ ~ .... ~'~4 ~ . ..... P operty Address_..._..~¢.-..:.-_., ...... _~ Septic tank: Minimum liquid capacity with distribution box ~'~) Gals. Subsurface Disposal Field required__ /,~ Lin, ft,.~ '~ Width of trench __ Lot survey Other requirements: issued by: ft. Record Of Individual Sewage Disposal System iNSTALLERS NAME o ..'~7~'-~ 2.-"~"' [ A d d r e Total number: Living units ~"'/'~r~ I~edroorns_ ~-- ..... Basement: Yes [] No,,[~. Water supply: Public system,. Individual well ......... Community system Septic tank: Distance fromm.veil ~",~ feet, Material ~ J No. of comportments__, Total liquid capacity ~ '~]~ .ft, __ gal, inside length__ Diameter ft. L~uid~,,depth. rile disposa~ field: Distributi..o~ box? Yes.[~"~j'qo [] Length of each ne .... ~ ~.,~ Tota~ length of all Pines ~ ~ ~ Width of trench ~ ~ ,~ Total square footage Distance between lines ........... ~ ~" Type of filter materioh Gravel: ~.~ Depth oJ filter materiol over tile Other Sketch of installation. __ ft, inside width.__ ft. fl. Dlstanc~ from: ft. Well ./~ ft. ft.. Nearest .._ft, Lot line: Front [] Sid~ [] Rear [] Foundation ft, __ Other ........ Depth beneath tile, ~ inches. inches, Deplh of tile below original groun~l surface /*%-'~-~ inches :, th~ Health, Dept, Indicate Northerly direction. Inspeclion will not be made until completed form is returned System apparently will ~-wlll nat [] (FOR HEALTH DEPOT, USE) function satisfactoriIy, and is therefore approved ~'~'~'~'~'~'~'~'~'~Disapproved [] Copies: (I) Orig, HD Files