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• 02/18/98 16:18 /c' NO. D05 <br /> Seepage trench bottom area planned ;Z R FO width 10 - . • • <br /> linear feet .57 1 depth 'VIII , <br /> Hawse- 900 to <br /> Seepage bed area planned width <br /> linear feet 45 depth <br /> Seepage pit planned outside diameter <br /> depth below inlet depth _ <br /> 4. See approved plan for specifications and details. <br /> Signature of person completing form: STATE DIVISION OF HEALTH, PLUMBING SECTION <br /> P. 0. Box 309;. • on, Wisconsin 53701 <br /> - S.ri�� �4d+ <br /> /. //,43" 1•1 Li Approved: - - <br /> i.jirlz-,,Ag <br /> Address: _�O W �ti g r r y $t Date: JUN - 1 1912 <br /> (3e-c-v4e to r ZIP 53✓-J / THIS APPROVAL IS BASED ON STATE PLUMBING <br /> CODE REQUIREMENTS AND DOES NOT EXEMPT THE <br /> Date: /N..r 4 _ fY7R INSTALLATION FROM CITY, VILLAGE, TOWNSHIP <br /> OR COUNTY REGULATIONS OR PERMIT REQUIRE- <br /> MENTS AND SHALL BE VOID IF REVISED WITHOUT <br /> THE WRITTEN APPROVAL OF THE DIVISION OF <br /> HEALTH. <br /> DEPARTMENTAL USE ONLY THIS Aa?,^,OVAL SHALL BE VOID IF <br /> NOT INSTALLED WITHIN TWO YEARS <br /> FROM THE DATE OF APPROVAL <br />