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l 3 722- H€ . i-� <br /> Address _ ,Permit-Number ber <br /> SECTION 3: As-Built Plan of the Constructed System— <br /> INCLUDE:•North Arrow•any/all streets•Distances from house to tank/tank to d-box i lend of lines well to drainfietd <br /> 0 <br /> 9Q,6 "-r- <br /> \L <br /> .., <br /> v xi <br /> om/ ; Iro <br /> \ <br /> T <br /> T-QJ . _,6,n0,�g��r,,11/ , 1 <br /> t' b�'"",�Jd'I`� <br /> it'. s 40(10(.4144 <br /> 'vw- / • <br /> /tR <br /> Y . 1)L!4,-y v) i Yt1 <br /> +A <br /> A4eic .fitt ‘f::-- . <br /> • <br /> APPROVED AS-BUILT <br /> DRAWING ;w <br /> • SECTION 4: Construction was performed by: <br /> I certify the information provided in this notice is correct, and the construction of this system was in accordance with the <br /> permit and the rules regulating the construction©f-onsite sewage disposals sterns(OAR Chapter 340,Divisions 71 and 73). <br /> Property Owner? Y 0 N t Septic Service Name /((I 3,y-02 Srl <br /> k <br /> System Installer's Name: in Certified Installer# /- �Z&er <br /> Print <br /> • <br /> !' <br /> System Installer's Name: 01°,41- Lam/ Date signed �� OG —2-7 <br /> Signature <br /> - <br /> City of Portland,Oregon-Bureau of Development Services,Site Development,Onsite Sanitation <br /> Phone:503-823-6892 FAX:503-823-5433•NY:503-823-6868• .�: 8/1/14 <br />