HomeMy WebLinkAboutPermit Septic Tank 1978-4-28
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Job Lo~ation IStreet, mile post~~'-< I) 3~4'3 ...3347 (&'-.}I4 z.) 8ol~ V~
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Subdivision .' Lot Block
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FOR SANITARIAN'S USE ONLY: ~ysteni Approved 0 System Disapproved 0 Needs Correction
COMMENTS:
Signature: .d ~/ Date:5~2-7!
FOR INSTALLER'S USE: Trench Depth' .10-/8' Filler Depth B~lo~ IP "
Tank Capacity )kb ManufacturerJ46,LLIJ-NJfElffi- r~~y5/f)N fE,
Measured distance to well from tank ?to from drainfield fp{)
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INSTAllATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION
When signed by the County Sanitarian, ~his certificate is evidence as per ORS 454.665of sat-
isfactory completion of a subsurface sewage disposal system at the above location.
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Return this form to: Permit Processing Section, Department of Environmental Management,
Public Service Building, 125 East 8th Avenue, Eugene 97401 ' C55-11