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Property Address .-~-~-~;L,~. BO~i~--~ <br /> <br /> MARION £OUN]¥ HF~UN DFP1.-SmCtation Speciticatio ..... ~?~/.~(~ <br /> A~Ora <br /> <br />S~b~,~ac~ ~i~p~s~FMd r.qu,r~d~. ~6_ Lin ft. ~Wdtho~rench __~, Ft.~ , <br /> <br />Other reqvlreme~(C~/~ '~"~ _ <br /> <br /> '~cord 0£ lMFddu~! ~w~¢ Dis~s~ <br />To Be Comp)e~ed by <br /> <br /> Other__ Deptl~ beneath tile (9 I * ,- inche¢~ ' ~,0 ~,~z~ ~'/ <br />____ir, ches Depth at hie below original ground surfo.,¢ ~;~," <br /> <br />;kofch Ot msiallottofl <br /> <br />[;!,~ II~p,e¢ltol~ will r~bt be mode unttl completed fo,'rn is returned to the Health Dept <br /> <br />Cop~es,,, {I/ O¢,g- lid Files <br /> <br /> <br />