A30 84Person County Health Department
Existing Sewage System Report For: Mobile Home Replacement ."��
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kequestee: �i�(1� +� �N�� Home Phone# S�Q 59�J
��Q ��rp.p�y �c� � . Business# 5g-7 –17�{�
'`��.�.^�C�'(Z�. J�►l.�d` `��-� 'Pax Map#
Location/Directions: ��S ���F–�`\n I��'�'`-`�" -
Original Permit Located �
Septic System Desiqned For: _
Etesidential Business Other (speci�y)
# Bedrooms # Employees Other _
Uate Installed __� ] Water supply ���
'Pype ot System
Nitritication Line
Tank size � j —
Certified Operator Required ( v � – .
On site wasL-ewater disposal system showes no visually apparent
malfunction on D� v
Yermission is granted to: ��(.� � �-�..%–
According to the attached site plan.. -
Comments: �n�'�\X�t1C� �.� � �CJ_��.�Z"� � �'J� �/� —
Environmental Health S v.
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