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LOT NO. :�_nnnxEss: 36 Dy�, 1�YI �2��
OIJNERS NAPiE: �e.inc. I
SEWAGE PERMIT NO. : NEW:�/ REFAIR:
DATE ISSUEll: DATE IPISTALLED: u/;o/Ff7
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YC�STALLERS NAME : �/;�.�:a,
INSTi4LLATIOPJ OF:��v.�..,,.,� ►��/}ov �Y��o."�- 2�flo�-�
WATER TABLE: IY�'�`�F�'INSPECT�ON BY��1'[/,�.,. .
SI�rlo�
DIclRWiNG OF It3STALLATION ON REHERSE SIDE:
Q"`�` �
; , Q� � rb' B
�+� - l r�
p - �a� � - 29,s` � `
F. ' 28' k • �-�•�` Q d
�. . 3� .s� F- 3e.s'
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