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A31 23aaar�s �o� S�Y� i-� � 1�, � r-- � E No. of persons to be served Bedrooms 1, 2,�4. Additional appliances to be used: Disposal, dishwasher, washing machine �1,�� 0`� � . Recommended: Septic tanl�—� � � �t/ � _ Nitrification line: ~�� , � � , Above recommendation based on information received and observed soil condition. Septic tank and nitrification line must be inspected and approved by a member of the Disfrict Health Departmeni siaff before . any portion of the installation is covered. Date Approved: g — l�}— �� By:. Countersigned SignecL Sanitarian O. David Garvin, M.D., M.P.H. District Health Officer (Over) • ^a + re } r; .:.: . NOTE:, ��Viake sketch of installation showing location of house, septic tanks, privies, water supplies on _ r:.`•' ��djacent property, etc. �1Vrite in measurements in order. that installations may be located at later � ,date. � . . �..,.�..�...� SUGGES�ED INS ALLATION (Date ' ') FINAL INSTALLATION (Date ) � Road or tre t) . (Road or Street) :� � �.y, � � • .y 9 r��+' . � ,,.� ��, ..�• � { -�r�'4.� ... �. jr . .... � -. , !-� .. -; �• .. , __ ._.�_ ,....... ... ...�.........-.a w�...-.w....,...-r ♦. . ....._::� ..... . ..,.....:... .....,., .,. .. .. .. . .' " f� {. , . ��^w. � '� n, s 7 `'�... .:•c........,. j � ;� ;� . - . � y b� �k � .. ., `� * �� s j i� , i f� � . �.f �, : .M: r, 3 � i � - •""' �R A ,, � � ' :'�''�, � +� �,��. � + . ji � ��. ., t � '` +� 3 � ' "" 9 q, : } � '•4 ) � � •• � . �+{� � . '�i ' f `R�' `� s 4 � �,rv� . �. . j ��i . -, . . . ' .. . : t.^' � �'�`" .�... �e. t;, ' --w � . — Y�Y` . �� . .. . ��} :a, _, � . . �'S4 r; y �';,+; �,. VdVb � .� �� ' g� � �-�� . � � , . �� '� � � �i � �' � . � � � � - �-� � � o_ � - _ y�� . _ � . � � � � � . r�� r� y � bS z � . � � � �C t�' � . �, �, i$ . �� ...Q� � �. � �� l � �� . f� ��. � ' �� ,� .. a � �� . �� .. . � � . � . � � 0 �� . I�� I �� ,� - ��t�>�_�.�_�. �: �_. , . ._� . . . ._. � . , , _. � � � _ _. � � � � Tax Map # Pazcel # �� Existing Sewage System Report For. __L/�iob�le g3ome Rep e� eryt,�� Addition Tqpe• � �� "l �v�,�'�'V • Home Phone# Requester: �'1 � Gt,� Business # ✓"� � � ��7 r � Location: � � ��c�� . Original Permit Located: '� Water Snpply: t/�V`-'-� Septic System Designed For. �esidential Business Other # Bedrooms�_ # Employees Other �r r � �� 3 � System Tppe:l � v�Vew�t �'Lc�. l '�ank Size: ( � � �, Nitrification Y.ine: � � } • �� . � Date Installed• ��%'`�0 �_ Certified Operator Requised: On-site wastewater disposal spstem shows no visual signs of malfi�nction on 1� r��4� �.�' �.'ermission is granted Comments• ` �� /�V-�w • iC Environmental �iealth Specialist ,r�� Date: �`'��`f, � � .. . �� Jl.G�� `l�� `_' - —,— c� �� T�C�Y 7��3-�,rn,,,,-„��¢.�.lL IE�T��.Il¢l� SiTE SKETC� Name Tax Map # Parcel #, Subdivision Section/Lot# Authorized State Agent Date System components represent approximate �contours only. The contractor must, flag the system prior to beginning the installation to insure thatpropergrade is maintained 0 Scale: �� a�� 0