HomeMy WebLinkAboutOP10/28/04 12:03 FAX 19108260341 HPS RELOCATION UO2
HAl2NETT COUNTY HEALTH DEPARTMENT
HTE - - �' 2 ENVIRONMENTAL HEALTH SECTION 17126
OPERATIONS PERMIT
Name: (owner) i t -N ,YR c A.New Installation Septic Tank
Property Location: SR# ) H r _ 0 Repairs Nitrification Line
Subdivision �` �T��''�' �-t a �" Lot # J
Tax ID 4
Contractor= l<<'
Quadrant #
Registration #
Basement with Plumbing: 21 Garage:
Water Supply: 0 Well I Public 0 Community
Distance From Well: ft.
Following are the specifications for the sewage disposal system on above captioned property.
Type of system: [1 Conventional Ll -Other �� ( L'. t
Size of tank Septic "Cank'_ 333 - allons Pump Tank: gallons
Subsurface No. of exact length width of 2 depth of
Drainage Field ditches ._' _ of each ditch _00 ft. ditches J ft. ditches t&aq in.
French Drain Required:
PERMIT NO, 2 3 � � j
11 `
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near feet
Date: 0 ' _ D�
Inspected by: Uc_ (,
Etnvirontnental Health Specialist
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