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MARIUN LUUN I Y HEALI H Iii-PI. -Sanitation 5pecitications~e~ ~,.o.~ <br />Dat~__,~,_.l ~9] ~.- . ,.~,~ <br /> <br />Permt~ I~ued fo:..,~..~._..~hill&p~ 363-683~ ~roperty Addres~ ~ <br /> 7/- .~/¢7 <br />~eplle tank: Minimum liquid ¢opacily with distribution box -/~ Gals. <br /> <br />Sub~urtoee DIspo~W Field r.qulred .... ~L[n, ft, ~/' Width o~ Irench ....... ~. fl <br /> <br /> Record Of Individual Sewage Disposal System <br />To Be Complmed b..b~pjtaller ,~ ...... -./-~ <br /> <br />Talc4 number: Living units ,, Bedt'ooms ...... Baths__Bosemenh Yes L_l No U <br /> <br /> Water supply: Public system .... ~_ ,.. Individual well <br /> Septic tank: Dit~ionce from well feet. Material <br /> Tv~u~ liquid CODOCIIy... gal Inside length <br /> Diameter ....... ft. Liquid depth <br /> Tile dlsposal field! Dilti'tbulion box,9 ~No ~ Other <br /> Le,~gJh <br /> ot each Ilne~ <br /> To~ol length ~f oil lines ~ ~ fl. <br /> Width of trench ~ ~ <br /> <br />Type of filler malarial: Grovel: . .~vz¢ ~' ..... <br /> " Other',,, <br />OepH~ O~ fll~er mrer~a~ over Hie ........ <br /> <br />Sketch of installation, <br /> <br />,.Community system., <br /> No. of comparfmonts_ <br /> fl. insld, width .... <br /> ft, <br /> <br />ft. <br /> <br /> DIstance from: <br /> Wetl ~,.,. JL <br /> <br /> Lot line! Front f-j Side[] Rear [-] {t ........ <br /> F au ndatian.~zz~_.~fl, <br /> Depth beneath tile ~' ~inche~.. <br />..... inch.s. Depth of lil~ below oricnol flrou~ ~uffoce~lnches <br /> <br />Note: indicate Nodherly direclion, <br /> ~nspertion will not be mode u,"4il completed form is, returned to the Health. Dept. <br /> <br />(FOI~ HEALTH DEPT. USE) <br /> <br />Syslem apparently will ~w~wHI not [] function satisfactorily, and is therefore approved ~sapproved [] <br /> <br />Remarks ...... <br /> <br />Copies: (1) Orig. HD Files <br /> <br /> <br />