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Dote. 4-24--72 ivlnl%i¥1~l ~l./ullll i II~LIII ~Li I'. ~JUlIIIUII~II J~lll~ll ~ - ~/ <br /> <br />Permll I~ued To: ~e ~e~ 362-~395 . __Pr~erty A~re~ ~ A~sville <br /> <br />Subsurface Disposal Field required~_ ~ ~ Lin fl ....... Width o~ trench ., ~q lt. <br /> <br />Other requirements, <br /> <br /> l~ued by, <br /> <br /> Reco~tml Sewage Disposal'System <br />To 8e Completed by Installer <br />rNSTALLERS NAME ~.__Phone No_~..2~?O~ <br />Total number: Living unit/ ~ Bedroom~._~ Beths ~ Basement: <br />Water supply. Public system .Individual well ~.~ommunlty Fystem <br /> <br />Total liquid ~-opa¢ilv <br /> Diameter ..... <br /> <br />Length of each line <br />Total length o} oll lines ~,~ <br />Wi~m ~ trench <br />~otal ~u~re ~otage. <br />Di~lanc~ between lines ..... <br /> <br />gol. lnside lenglh__ __fi inside width . <br />fl_ Liquid depth__.__ ft. <br /> No [] Other <br /> <br /> ..... ft. Dt~tance from: <br /> ft. Nearest <br /> <br />fl <br /> <br />type of Jilter malarial Grovel: <br />Depth of filter material over tile <br /> <br />/~ '"~ Other Foundation .... h <br /> , Del~th beneath tile ~ inche~ <br /> -,,--~'~ inches, Depth of hie below original ground surface / ~ inches <br /> <br />~ketrh of installation. <br /> <br /> /,.?- ?a <br /> <br />~yslam apparently will ~ will not ~ <br /> <br />indicate Northerly diracflon. <br />In~pectlon will hal be mode until completed form [~ returned to the Health Dept. <br /> <br /> <~g~.~. ~:i;SE, .... / ~-' : ""~':" <br /> function satisfactorily, a*8 is therefore approved ~ Disapproved <br /> <br />Remark~ __ <br /> <br />Oa,e fl- <br /> <br /> <br />