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Health Department � s/� <br /> Identification Number d L d' Q <br /> Schematic drawing of sewage disposal system and topographic features. PAGE = OF _ 4 <br /> Show the lot lines of the building lot and building site, sketch of property showing any topographic features which may impact on the design of <br /> the system, all existing and /or proposed structures including sewage disposal systems and wells within 100 feet of sewage disposal system and <br /> reserve area. The schematic drawing of the sewage disposal system shall show sewer lines, pretreatment unit, pump station, conveyance sys- <br /> tem, and subsurface soil absorption system, reserve area, etc. When a nonpublic drinking water supply is to be located on the same lot show all <br /> sources of pollution within 100 feet. <br /> ❑ The information required above has been drawn on the attached copy of the sketch submitted with the application. <br /> Attach additional sheets as necessary to illustrate the design. <br /> S ,,4 e) PZ/07 - /1L/�7L� ' A/vl£ .fo /}. <br /> . ' '(X zw7‘ d / / /,�� <br /> ,-7 eeLe ?.yr -z A/Sf ,4 <br /> 7 <br /> L/C GJ 7e , Sc- /2 .V/5 Lv/ is✓ /4' f./r , <br /> Can/u ec i�cn7 T 2e, 7N fs / 7 Tom Y - e 72. Be'" <br /> d A 7 Reo p .riz f <br /> 724-e ez,Q.ss- Tl i i -z <br /> �ireL / i$ XL6o /n�v Y. <br /> 77V S - 7 S W4 Ceti. -S/ z ZeZ D 72 l�L,f ?i <br /> -f/. <br /> The sewage disposal system is to be constructed as specified by the permit i5a attached plans and specifications ❑ . <br /> This sewage disposal system construction permit is null and void if (a) conditions are changed from those shown on the application (b) condi- <br /> tions are changed from those shown on the construction permit. <br /> No part of any installation shall be covered or used until inspected, corrections made if necessary, and approved, by the local health department <br /> or unless expressly authorized by the local health dept. Any part of any installation which ha been covered prior to approval shall be uncov- <br /> ered, if necessary, upon the direction of the Department. <br /> Date: W��> (r Issued by: l ` ' This Construction <br /> Sanitarian Permit Valid until <br /> Date: Reviewed by: , PA-we /999 <br /> Supervisory Sanitarian <br /> If FHA or VA financing <br /> Reviewed by Date Date <br /> Supervisory Sanitarian Regional Sanitarian <br /> C H.S. 202B Revised 6/84 II -2A <br /> FILE COPY <br /> • <br />