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MARION COUNTY HEALTH bEPT;:'-Sanitafio S <br /> <br />~Pllc lan~ Mlnlmum I~uld'~apac~y wllh distribution box ~ ~ Gals. <br />O~lr requlremenls~ <br /> <br /> Record Of Individual <br /> <br /> Total number: tiring units- / ~ . . . ~edroom <br /> Water supply: . Public system~. . Individual well . ~ <br /> Septic tank~ Dlsta~e from well,, .~ leet. Material <br /> ~e~l liquid capacity ~0 U gal. Inside length~~ <br /> .-~ Olameler.~ ft. Liquid depth ~ '~ <br /> Tile disposal lleld; DIstrlbutton bo~? Yes ~ No ~ Other <br /> Length al each line //0 v <br /> j ro~l length of al~ Ilnes~~ (l. 'Dislance from: <br />Width of Irench~'::'~v~? ~ . h. Well <br />~.~ro~al ~uare-f~lage ~<~ .......... ~ft. Nearest <br />Dbtance be~een Ilnel ~- ~ ~ ~11. Lol llne~ Front <br /> <br /> Depl~' of Illler hateful ~e~:lile - ~ ....... IncheS: Deplh d file bel~,'or~l~l <br /> <br /> Yes D <br />Communlfy ly <br /> NO. of coml <br /> .~1. inside width ~' '* <br /> <br />ft. <br /> <br />' Inspection Will ~t"bl'made until completed folql~ Is returned to me Heailh, De <br /> <br />'1 <br /> <br /> Signature u/ Installer <br /> <br /> tFOR HEALTH DEPT. <br /> <br />function saltsfoclorlly, and Is Ihereiore approved <br /> <br /> <br />