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Dote__~_~.~::ZO~ MARION COUNTY HE&LI_U~pI:rl. -~amm.on .~l~=,.,,,,.~,,,,,,,~umb,r_ ~.._ <br />Permit l~sued To:~K~"~,~:/'~ ,~r'~'"~ ~-~774 ~¢Ol",eety Address R~*~,, .~;x ~196.-~K . Au_---'~ra ...... <br /> <br />s~ro~ O~posa~ Fle~e ~e~uired~ ~Lin. f~_~" W~dth ~f trench .... <br />Lot survey .................. <br />Ofher requirements; <br /> <br /> R~cord w e <br />To 8e Completed b~ <br /> <br />Total number." ~v{~oLi i~g u~lts = '/ ' Bedr0om~ ~ ,~aths ~ So~emen~ Ye~ <br />Wa~er supg~y: Publi~ ~y~tem. , ~, Indivt~ual well ~ Community ~y~t~m <br />Sept~ ~nk~ O~ston~e from well ~/~' , feet, Mater,al No. of comporf~en~s~ <br /> <br /> ~ ~t L;qu;d depth ~ e ~ <br /> Diameter ................. <br />Tile ~isposal fietd: Distr~butlon box? Yes ~ No ~ ~her <br /> <br />Tc>toJ Jeng/'h of a~ lines__ ~,~ e( ft. <br />Width of ~rench ......... _~.~ fl_ <br />Tota~ ~uore f~otoge~ _ .,,;; ft.. <br />Dl*tonce between ltne~,, i, .~ ~ ~ ,fl <br /> <br />Ty&e of filter meteri,~l~ Grave - ~'3 ~ ;4 ~, , _Other <br /> <br />Well_ /c~c.~ ~ _lt. <br />Nearest <br />Lot line; Front [] Side [~ Rear <br /> <br />filter material over tile _- <br /> <br /> ~0~e~ IndTcate Northerly direction. ~'7~--.-,~_~--~ <br /> Inspectlon will not be mode until compleled fc~rm t~ r~urned t'~he Health. Dept. <br /> <br />........ . ....... ~l. : ; l,;o~,~,,, o~;. &~, / il:-- ' .l~ ,__ l:ll .... <br />System opparenlly wlll ~ wlii nat ~ ~unction s~tisfactorily, and is therefore approved ~Oisapprovod ~ <br /> <br />Remorka ...... <br /> <br /> 7/_ <br /> <br /> , Depth beneath tile ~ inches. <br />_inches. Depth of tile below oi';ginal ground surfoce/_,'~'- ,2~ inches <br /> <br /> <br />