OPHs_ SETT COUNTY HEALTH DEt'AR TENT
ENVIRONMENTAL HEALTH SECTION ~ ~ 15943
PERMIT
1PERATIONS Name: {owner} t-**'E KI o Lc--"l New Installation Septic Tank
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Property Location: SR#s~CL~q ~~-X- v o, Repairs Nitrification Line
Subdivision
Lot #
TAX ID# Quadrant #
Contractor: Registration #
Basement with Plumbing: 0 Garage:
Water Supply: Well Public Community
Distance From Well: 100 ft.
Following are the specifications for the sewage disposal system on above captioned property.
Type of system: Conventional ❑ Other
Size of tank: Septic Tank: 100 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches` of each ditch 510 ft. ditches ft. ditches in.
French Drain: Linear feet
Date: `v
I %I
PERMIT NO. IT5 iLl Inspected by: ~
Environmental Health Specialist
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