Laserfiche WebLink
I INDIVIDUAL ON-SITE SEWAGE SYSTEM REC, J] <br /> WJ n'ION[Wi °w.oc"°lantEC-m"_ (to be completed by system installer) <br /> G m1p <br /> Jss CdutLVLSION 14]W <br /> sees OltFntsBse 3 . S7 .G4,1 f 1 <br /> tsce sa me .SITE ADDRESS: ) ., 1! <br /> ../X„ <br /> SERMI'S NO.(I; '� 4 <br /> AS-SLUT PLAN OF CONSTRUCIXO SYSTEM: <br /> II <br /> scale: 1" _ i I <br /> North <br /> j l 1. 5 saki r <br /> 6aiti1Jv �,""--+ <br /> uvfl<r <br /> pc,-kiiv +4iS�1s1 A- at <br /> • I e, p it if oa Car._ <br /> t5f.1/ -(.pp <br /> typeadrr <br /> • <br /> �,++ i 4vSndr <br /> • <br /> K ®oatK / it <br /> Il 1' a. S'>r to W 7 <br /> get in <br /> va <br /> Dorms e aL <br /> (show all details and dime &ions necessary to locate all components of the system in the Future) <br /> arum 1LaTIMULS an SPICIVlantMs: In. TaAnw tlmtRZ I ZCl: <br /> Sparta Desist Saes. )ion: analous/Pay I MAIMS OMELET TEAT IDE Cal-stfl UWE <br /> SYSTEM f.`✓ Nat'l, e mg: teArtir SMOOT=IMIN .tecogD/O a MITa'f8E DIESIT 1mFTT OF <br /> septic tat: sire: /�� <br /> w TEE MUM co AND 1'EE SIIId9 OF 9B 8pVE8tlUatLN. <br /> Donis, lank; sire: ��O[9 ouc l: yx9: /it)s: 1 I Iv have tanned <br /> !l .1 j x SLe a ware the Septic mans and certify <br /> aZSlwti Beres Sia�s:[/� �� WC'l: �1�li/ (" Yo �� 12 Le be watertight.' <br /> Ades): ( I nist34/C Drop / IV Concrete; ( I Plano The eyetew vas Installed by: ' : <br /> ////// �ryT) � I I Property owner ;Dextdtee) <br /> 'br.SatSeld Sipe: Size: Y i Material: Header:T p�isi : Porn: C. is Licensed sear S •q a\ Strain <br /> meal oninil la-spits,.:/2sa, Soot DwStn. Tanta: F. a.: ert,m, Dw [Scene <br /> latama. w n Dla:iela M.tertala: �7—/'/et✓ s� <br /> • <br /> u <br /> / ssg ea: <br /> rewash Depth: %inimnQ,y : samlmte�a� : Curtain oreln Depth: /Yo ,�j� j/ �j f'� '. <br /> M2f art S¢mpt map Hotti: /�Mt l� Static ad in System: a� Pt. CumYti'liana: {jdG ,UiiiiiltodEtat <br /> / "'JC wV .,a..!((NxyjSp�j ipl ease print) // /p// / i <br /> PIA* Cycle TSw:35;tnlrnb..lona per Cycle: mEl: i' tyj a l.�f. <br /> • <br /> Attach u addltieNl abele to et®¢Data and materials swat. Lined'ann., - <br /> (20X Marital Canty 'ten only] <br /> The eve Septic system ban been inspected by Marion County. The information ➢ere Deen determined TO be accurate a and ' <br /> tb ytten is: . !' <br /> Approved <br /> I 1 Approved with CorrsctiOns: Bee inspection report <br /> I 1 vented {,(�.�)/� e C + yq� <br /> SignedDw / lWr ,tf lino:' ow J rate I .a_al _54- <br /> X81S8:Mar¢en *limy: 1T:ITAM:Naer: PIID&:Iuetdl2er <br /> _. _--tele, S100;6;01 _ .-.. _..1. <br />