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~ ,~, MARION COUNTY HEALTH DEPT. -Sanitation Specifications <br />Date .............................................................................. Number -~'., - <br /> <br />....................................... .,,,,.,,. ............................................................................. T..., ............................... ..,..,,,,~,,.,,..,.,...,...,..., .................... ~: .................. ~ ........................... <br /> <br /> RECORD OF iNDIVIDUAL SEWAGE DISPOSAL SYSTEM <br /> <br />CLEAN NO, 2 ROCK; <br />Depth under tile .................................... inches, <br />Depth over tile .................................... inches. <br /> <br /> Depth o~ tile b~low oriqtnal ground surfaco ................................. :.. inches. <br /> <br />Dl~tmace lmm: <br />Well ........................................ It, <br /> <br /> Neap, est: <br /> <br /> Lot Ilne: Front [] Side FI <br /> <br /> Foundation ........................................ lt. <br /> <br />l~o~r [] ............................ lt. <br /> <br /> igote; Indicate Nor~herl¥ direction. <br /> Inspoctinn will not be made until completed form is returned to 14~cllth Dopt, <br /> <br />DATE .................................................... $iqnaturo of Installer ............................................................................................ <br /> <br />System apparently will [] wilt not [] <br /> <br />~O~t I-I~ALI'H Dmz1'. USE) <br /> <br />Disapproved [] <br /> <br /> MARION COUN'f¥ }IF,,~,II~I D~PARI?4~I~ <br />Date ................................................................ <br /> <br />Copy (1) Orle~inal -- MCHD files <br /> <br /> <br />