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MARION COUNTY <br /> <br />Seplic;tonkt ~Ail',imum Jic~uJd capacily with distribution box <br />~s~rrf~ ~isp=~d required / '~ ,Lin. fi.. <br /> <br />C~I)EPT. -Sanitation Sp~cificati0nsNu,~ber <br /> <br />Property Addrel~~ <br /> <br />Record Of indi~uaI Sewage Disposal System <br /> <br /> No, o( comportrnent~ <br />inside width, fl. <br />ft. <br /> <br /> .... Phone No, .. Adc~ress~ <br /> Bedrooms~__Bath~ .. E, asemenh <br />Individual we}l __.__Community system <br /> feet,, Material <br /> <br /> '1'o I~e Comple?d by Installer <br />INSTALL I"RS NAME <br /> total number: Living units <br /> Water supt~ty: Public system ........ <br />Septlc lonb Distance ~rom well <br /> <br /> Diameter ......... <br />~i~ dlsposol field: DistrlbuHon <br />Length of each line <br />To~al length of all lines, fl. <br />Width o~ ~rench ...... <br />T~taJ ~uore foologe' . <br />OJslance be~een Hne~ .......... Et. <br /> <br />_gal,, Inside length ft, <br />__ft_ Liquid depth ~,, <br />Yes [] No [] Other .... <br /> <br />Well~___fl, <br /> <br />Lot llne: Front [] Side[] Rear [] fi. <br />Foundation ........ <br /> <br />Olher <br /> <br />Type of fitter materiel= Grovel: <br />Depth of filler male,-iai over tile <br /> <br />Skelch of ins~all~Hon~ <br /> <br />Inches <br /> <br />indicate Northerly dl(ecllo~/. <br />inspection win not b~. ma'~e until cornpleted farm is returned to the Health. Dept. <br /> <br />System apporenlly will ~ not E] <br /> <br /> Signature of Installer <br /> <br /> ~FOR HEAkYH DI~F'~, vs~E) <br /> <br />function satisfactorily, and is therefore approved [~'-~isopproved [] <br /> <br />o ,e <br />Cop[e~': {1) Orig. I-ID File~ <br /> <br /> <br />