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Marion County <br /> <br /> OREGON <br />COMMUN]TY D~/ELO?MENT <br />DEPARTMENT <br /> <br />PROPERTY OWNER: <br /> <br />SITE ADDRESS: <br /> <br />SITE NUMBER: <br /> <br />SEPTIC S¥STE~ CERTIFICATION <br /> <br />I , hereby, certify that the attached site plan is an accurate <br />representation of the conditions on the above described property, <br />and that any proposed'structure/property division, meets all of <br />the minimum setback requirements from the existing septic system, <br />and the future septic system replacement area. <br /> <br />I further certify that I have, to the best of my abilities, <br />thoroughly inspected the septic system and found no evidence of <br />any failure. The system appears to be functioning in a satisfac- <br />tory manner at this time. <br /> <br />SIGNATURE: <br /> <br /> ~/9,~/~,~ ~, ~po~_~ D~TE: <br />(property/owner/authorized agent) <br /> <br />NAME (please print) <br />MAILING ADDRESS: <br /> <br />MC15-S38 <br />REV 3/93 <br /> <br /> <br />