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MAKIUN L,UUN I Y U~.RLI I1. Ul:r I.. bamtatmn bpeahcatlons <br /> <br />Record Of Individual Sewage Disposal System <br /> <br />To Be Completed by In,taller <br />IN$1ALL~RS F4AMI~ -~' , /..~.~.'.. ~ r'' ,~ Phone N~. ~ ..... Add~s~~ '" .... ~' _ .~_' ' ~, <br />TO~I number. Llv~ng unlt~, ~_.. Bedr~m~oths <br />Water supaly, Public syste~~~ Individual ~ll ~ ,, Community system ,, <br /> <br />Totul liquldeapacity~....,~gol Inside length <br /> Diameter : 7 fL L~ld depth._ .~ '~ <br />Tile d~sposal held Dtatr~bulion bo~ Ye~ ~ No ~ Othe~ <br /> <br /> Total I.~ngth al~ all lines _,D ~ ,~ ft. <br /> Width of fr~nch ,~ .......... ft <br /> <br />~eplh of ~iller ma}erJ~l Ov~r Hie .... <br /> <br /> tot line~ Pro~t[~ $1der~l Reor~ ft.__ <br /> Foundation .// ft <br /> Oeplh benealh file~:/~. ..... i~he~ <br />Inches. Depth ~ tile bel~ arigi~l ground surioce ,' <br /> <br /> In~pechon will not be made until completed form is returned to the Health. Dept, <br /> <br /> ..., ,. {, <br />DArF,._ '~ ' ' Signature of In~toller , · 2 , ' <br /> <br />System apparanlIv will ~will not J~ <br /> <br />HEAL'TH JDI~pT_ <br /> <br />Copi*s: [Ib Orlg. HII~ Flies <br /> <br /> <br />