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A31 171
1 ����' _9 � ���� ��t�� ��.�-_. � ` � ,.., *� � � ..� �! � Ji ��-��.�-���.-n-n ����.IL �-7I��Il��. Tax Map #�� I Parcel # �� I Existing Sewage System Report For. � Mob�e Home Replacement - Addition Type• Requester: �'� �. Home Phone# '� `% -�� Y/ o� l� �'.�-f �.� ��o 1� susiness # �l� - `73 a -- ab$5 f�.Q� N�-<<�. i� a��-c i Location: �-I�i � � � art l���- G�.D,�l-�'a.i� � --� � �, l�.h ��,re f� -� �- C.rL. oF r� � � . . � Original Permit Located Us�� Water Supply: ��ci-� Septic Sqstem Designed For: �Residential Business Othex # Bedrooms 2 # Employees Other System Type: ��w..Q� Ta�k Size: fl Nitrificadon Line: (�' k C9 � Date Installed: `? �a(9�-`? `-f Cerdfied Operator Required: C10, � On-site wastewater disposal aqstem shows no visual signa of malfunction on c`� -� - C��-i Pernussion ia granted Comments: �I �c�..� �s �e S(�.�9zQ. - — — _LL ' " N/�M..Y� IL �.. n � 1 Environmental Health Specialist Date: � � � F ' � . :`��i��� � ���vJ�� ..- : ' ' � � �Z:T1��� �.���-m,�„,�„-�e��.�. ����.�: SiTE �S�gETCI� . Name V-e,t,.�. tvW-w�- Tag Map #'�31 .Parcel # �� t,l�,��� � � Section/Lot# � �� � I Co --��,/ 1lutho ed tate Agent � Date .; . . sy�7z ��� ,�,�� �„�„�����u� �y. The contractor mrut, fTag the system privr to . begmnr.'ng the instaAa�i'on to insure that pmpergmde is maintafned � ���'Ss �� Y �`^-� (�- � c�c�-� (,���— �-�- �—� E.,z - _ a � l�- � . Scale: � _