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. <br /> ■J t‘ ORANGE COUNTY HEALTH DEPARTMENT <br /> 12 <br /> ;5X EXISTING SYSTEM I NSPE26. 05. S 1 9865-68-5784 4.E3. '5 <br /> :IE: OWNER: <br /> JSSELL JEFF MAJOR BUSINESS FORMS <br /> 'O BOX 1299 <br /> HILLSBOROUGH NC 27278 P 0 BOX 1299 <br /> 732-2101 r-IL_SBORO: T3H NC 27278 <br /> .EPHONE: <br /> Ec:FPCATlONS L- T SIZE/�CAEAGE OESIG m.=WETLAND? <br /> ^_RP I. R SYSTEM "jD `41.4 .1174\'� p�/�/1oi�1� Ali YES <br /> �J NO <br /> CainON/DIRECTIONS: <br /> ".;.4Y 86 <br /> ' RECEIPT: SIGNATURE OF OWNER OR AUTHORIZED AGENT <br /> )NFRMED ere PLANNER DAB ARK <br /> li•w na✓s+o.rsdn7+..- <br /> . S 6uenSI f44 DISPOSAL A OTHER /� TYPE. SYS <br /> 3Z. T1:—)NK Uj SZ. CHAMB 2000 (\co\\'tf"%, ITRIFI 13.30 X...3i XIS" OPER. REGI Y <br /> R=MP RX3: = St si ht_1Q.1-.1 T suntr3L r__" i._14extmh_ `__itaQI-F;------ <br /> pn �hn,r . bra. pre- G a m-% ear% �irr-+vc.. <br /> • .4 s�Cvy� s t 1 tee, %ft4 a 1 col it aC.t.�r a ar+t.e. „�, 1 acs h prefaced C.a.7 <br /> ^ � S l\ T Zrv�sa :� � � <br /> �n t_`3 ho\\ co , 5(see. S <br /> • <br /> - ex;sri ,ks Shell be pie: <br /> ret ettib4esi ° i 2001 'lk aw-a#4,,l;fiara.cl,d /od. <br /> 1 /'� P • rilf, sSX0116L pnviI ihd aC4- <br /> ( presvrt.wweo+rog I f ° PorSo)Ai rerrvaolt <br /> !i�i , 1 q I�1ct,%riy° S, ,t/ ': nkt 1JC /ecL tit <br /> \ , if x r •r S?y'' r�h� 6aA i4'/fiy <br /> , .s, J <br /> !It �hI1°t s'.St � su <br /> eil <br /> \ Zgs ‘s,41 4 ♦ 04 .e 4 13 - <br /> AP z 44 0 ma.. <br /> a p <br /> Ts <br /> �r ,N zs ? : L/U : 2 - Te <br /> . s s f r- /3, iy- SO/ <br /> - 44c4 I y <br /> 9 <br /> needd ►p inIti / O PT- <br /> .P,�nTc�N� <br /> 1g <br /> iJ Ejlac!�-6.�:)�!"?�'�� <br /> ' V — \ <br /> 3" S��IeaW it�}O I Ie.:t pre-a wf <br /> slie IOW p rG- sett---t I ksia!!� rid-4440 <br /> Jew T ottilfc f <br /> 441154 <br /> DATE. ISSUED ___5-20-q/ SANS TAR I AN 7‘,7s,"4 Al <br /> :ATE. APPROVED _�'J0 I/ SANITARIAN F% � i� 0r. <br /> I <br /> tr./ A /-.ti <br />