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~ , MARIO~I"COUNTY HEALTH DEPT. -Sanitation Specifications <br /> D~ - ~,,,~vOJl~,28 -l, . ~ho~ ............................................... <br /> X"' ' ~. Albe'rt <br />4~ex"~nt ssued To: ................................................. ~ ................................................. 1:~ ¥ Addre:,~ ................................................................................................... <br />~pti¢ tank; Minlmun'i <br /> <br /> Sub~r~ di~poscfl field to~ulte¢l .................................... Lin, it ..................................... width el t~h <br /> <br /> Issued by <br /> <br /> $1qnc~ture <br /> <br /> RECORD OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM <br />TO BE COPIPI, ETED BY n~sT/ <br /> <br />Tote] liquid ca, paucity ................................ gals, <br /> <br />GLEAN NO, 2 ROCK; <br /> <br />Di~tr~,co lmm: <br /> <br /> Well ........................................ It. <br /> <br />(FOIl H~ALTI! DEPT, USE) <br /> <br /> <br />