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9^7i MARION COUNTY R DEPS'. -Sanitatre " "'' (anions'pate, '" + ..� a Number_ o
<br /> Permit.Issued Tot_.. Walter 1112.2,1042_.--51:1I-0- ! _,..P'roperty Address 'r�► `"�-- al
<br /> _ (off Kubler Rd Jo.) •
<br /> . Saptic tank: Minimum!Squid capacity with distribution box,_,.— -.,Gass.
<br /> Subsurface Disposal Field required_..r�. Lin. ft., r
<br /> - - Width of trench_.--84. ft.--
<br /> .
<br /> to survey ----•-------
<br /> Other requirements:
<br /> Issued by: ••"—'4424-41,....
<br /> Record Of Individual Sewage Disposal System .
<br /> To Be Completed by Installer
<br /> - INSTALLERS NAME_. .--.--...,, t, ...—.Phone No..._. Address
<br /> Total number: Living units _._-.. Bedrooms --.Boths_,._,.,,,,,,-t3asement: Yes 0 No 0
<br /> :Weter supply: Public system --- - -„Individual well--..---Community system
<br /> Septic tank: Distance from well—,- ; feet. Material-._ ,_,.— ,,.,..Ne. of compartments.✓,..,,
<br /> Totol.liquld copacily oat.Inside•length ft. inside widih... .._.., ft.
<br /> Diameter ft. Liquid depth ft.
<br /> dile disposal field: Distribution box? Yes 0 No 0 Other— -- ,.. .
<br /> Length of each line ,. - - __ ,.—ft,
<br /> . Total length of all lines_. — ......-___"--_ft. Distance from:
<br /> Width of trench_.. ,--_.�•._......._._. ft_ Well .ft,
<br /> Total square footage.",,,.... •—_--,.__ It. Nearest
<br /> Distance between-flees. ._._.. .. ----ft. Lot line: Front 0 Sider Rear 0 ft..,- -------
<br /> Foundation., _ft,
<br /> •
<br /> Type of tiller materiel: Grovel: _.. Other ._Depth beneath isle inches.
<br /> Depth of filter materiel over tile--. ' .inches, Depth of tile below original ground surface .inches
<br /> Sketch of installation.
<br /> 6)444;4
<br /> ' A/°7(-. 1;
<br /> 1) aride". ”. ///04 L4LR'elv
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<br /> - i'lr044"(dV at "fog 7
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<br /> 11°44 1'1PP/
<br /> Note: indicate Northerly rr c
<br /> Inspection will not be made until completed form is returned to the Wealth. Dept.
<br /> •DATfE_. __,.r.• • $tgnoture of Installer-„_,__
<br /> (FOR HEALTH DEM Lt$Ei
<br /> System opperently will CT wil! not ❑ function satisfactorily, and is therefore approved Dfsopproved 0
<br /> Remarks_.. ---_ . ... .. ..
<br /> _7(5 Pi, . .51:5Ar:_____. ,e.A.,..t , A- 01.
<br /> MARION COUNY1l T, , DLPARIM'.M
<br /> Dote_. -,,. ,....,-,Art,...,..- - •= .‘..,...., . --_—___.-_
<br /> copies: (1) prig,_HD Files .• ---,Pam 4.
<br /> _.- v e., ,
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