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<br /> MR QF#ICE USE. �#IOhE M 3ATW WrM IFFIFIM
<br /> f £Ceaspirts in Tse
<br /> This Fvmdt!m!we.,Yiar team Defthand Q ft saved..
<br /> Appikation;s hem 4s.ymode iv 117*Son iw tam*gmbh Ols*ict for a perr it to consvucr and imfall A* vwfk heroin
<br /> 1 dsictibed,This oWiplofm is made in complio-t=with C untY 0rdlft-a hl.-549 and"flinp Rvift and Rowatiom
<br /> JOB ADORMAOCATIQ I -''// ./,► !.I'� ! !a�;E.-.. s`� L f+harte .....
<br /> Owner's Nome r �
<br /> A:ddtest : - � . ��?:. f iS_ri6+f' _.... _.Clrf.,e 1 eft.._.
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<br /> f �fsafien ur�il Rift;d� �
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<br /> rastar'sNamtr - . f .-
<br /> Fi fl Conimereial©Traltatoun
<br /> Nu+itber
<br /> of IW-119 un;,u---.-.- fJuenLsm of 6ettraams,4--.-__Garbage cr€ndar to see
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<br /> wow&*Ply!P dg-wSyst m'omi name... ................
<br /> CFwssscnsr al soil too depth a{s fcaty 5andim p C* p poo© _ roam 0 Clay lain a a __
<br /> ItWdo"Cl Aare t3 F313 M6$Viat......:.. tl yes.gips ...... -............. .
<br /> lIMQt pian, *hWWinp the 91 lot, loeotien of system in melon to well:.lwiidi qs. etc. n%uv be pkiced an reverse sWel IJ
<br /> NEWT NSTAL1ATIOW. Wo septic fth4 tw seepoe pit pwmWed if t sewer is ovaRable wiileih alp Feet,} fk
<br /> PACKAGE TREATMENT I I SiEPTIG TANX ......................:e. 1i4uadIrmpth..............,...:.....
<br /> 03stasrse to nearest Well ,..... Fauredaslors. _........_,......_.Pmp,Una.:......:............
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<br /> LEACHING LINE I] tsa, of LLTm3 ...........,-. _..-. LWTgm at cad% ling..:.,.,.•_.. ........,...Teial ,,:,.:..,....-..
<br /> 'W fax .._ Type FRtet l404fiai_.,.,:.,.. Depth flit" ilRateriot ........ --11-111.................
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<br /> A+ttanoa to UW-6t.-Well Fwrndateon f4aperllr line ,.......... ..... .:a
<br /> sERPAGE Flfi [ } Depth , l .-._.. D¢ctnerer ...._.,.., I�tuml>. ........ .._,.,.-,rack flneA Yft p t»lo(] �
<br /> venter Tatum Depth
<br /> Distance to rieaeest:Well ..... ................ .........Feuridatiait ,��....,...... tln! ...........,_..,...,:..
<br /> R�AI>fll lFRev.5on.eeatlaat Lbt+nir ...............•..... -.__.- Oat9,:,:...
<br /> Oispasol field APetifY R"wiremcw.0-491�L-
<br /> Prow pxisteag and F"Uirest mmi ion an rc%cs a Tigw
<br /> I kw@b r ewift rites I l"a"ve poopim ills end dsnl A*+resit wal be doM'lhs"amudmm w t flan jamipulm
<br /> Coomy amonmmm Sime Laws.and Bid"tled lfegaFaiietts of am Sae 4mm #n Loge!!wide awjkL livens&wow x pms-
<br /> redafents dgnaturr sa+tytpiK live fiattawing=
<br /> . "1 cseiglr that to"owfoome""d,**work Em t hd&Alt pomkk is kw N4,t S641"ot Av*1 W ow is h m6 Raw
<br /> as m besanre to t}If s C+ sr�e laws of
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<br /> ;If othaT than awmmI ' f
<br /> ADR 0VAXVf&W USE WWI
<br /> APPLICATMN A=PTt D'eY..` ifwo .:.- -0A- ::...Z31 ......
<br /> BUILDING PIPAir ISSVED ,,,.,. ...................,..., .._._.._.----------..........:......,_ ...__....._...._.GATE ......................
<br /> Ap£#V0:NAL COMMENTS . . . - --------------- -.,., ...............
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<br /> fin�!lt+t
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<br /> )AWN
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<br /> &04 LOCAL HEALTH DISTRICT »
<br /> E.M.9 1-18 ROW,SM �
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