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Dot° ~0-~0-6~ MAR[ON COUNTY HEALTH DEPT. Specifications <br /> ......... /? ,_~ ,77/' <br />Permit Iss,Jed To ...... C- grickson ,SJ31-Z0.~._~ ........ Properly Address__~_2~ - <br /> <br />Other requir.menls:; ' / ~w ~-~ ' -- ~ <br /> <br /> "7~ ~ '{1 <br /> RecordOf Individual Sewage Disposal System <br />To Be Complded by In~ller <br /> <br />Trio[ number: living'ur, i,sT~.. C / /' Bedrooms ~ Baths ~ Basement:: <br />Woler supplz Public sysl~m. ~lndividuol well ...... ~Community system <br />5oplic tank: Distance +rom well .feet Malarial ~ ...... No of compartments_. <br />~otcd hcF~,d copa¢~tv.~__~ .... gal Insde lenflth Jt inside ~dth_ <br /> <br /> Diameter ft Liquid depth <br />Tile disposal field:: Distribution box? Yes ~ No [] <br />Length of each lin~ ......... ~' -~ f ~'-,,...~ ~.,~,~__'~/---~ <br />Total length of all lines_ , t <br />Width of hunch ~.~-5:-. ...... B <br />Total square footage ....... it <br />Distance. between lines // ~ ft <br /> <br />Type at filfo~ moferioh GraYeh <br />Deplh of fihu~ material over <br /> <br /> Other ....................... <br /> <br /> Distance from:: <br /> Well ft <br /> Nearest <br /> Lot hne Front [] Bide~ ~ear ~ ft <br /> Foundation __ ft <br /> Other ..... Depth beneath tile ,~ .... <br /> inches <br />.... roches D,pth of tile below original ground ~urloco,~U ./',/.z. inches <br /> <br />:Skdch at installation <br /> <br />Svdom apparently ~ill ~ ~,ill not [~ <br /> <br />Indicate Northerly direction <br />Inspection will not be mode unlil completed form ,s returned fo the Health Depl <br /> <br /> Signature of I nslolJ~r ~. ~_~__~.~-~ <br /> *FOF~ HEALTH DEPT USEI <br /> <br /> function solisfactority: and i~ Ih~refore approved ~ Disapproved [] <br /> <br />Date <br />Copies:: I1} Orig,, HD Files <br /> <br /> <br />