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MCBI POLI~y/PRO~EDUF~. <br /> <br />SEPTIC SYSTEM CERTIFICATION <br /> <br />section 1313 <br /> <br />Whenever a building permlt application ls submitted for an accessory structure <br />or alteration/addition where bedrooms (or sewage flows) are not affected, and <br />there is an existing septic system, the applicant must complete the following <br />statement. This statement is to be attached to the application/permit. <br /> <br />PROPERTY OWNER: <br /> <br />SITE ADDRESS: <br /> <br />SITE NUMBER: <br /> <br />SEPTIC SYSTEM CERTIFICATION <br /> <br />i, hereby, certify that the attached site plan is an accurate representat$on <br />of the conditions on my property, and that the proposed structure meets all <br />minimum setback requirements from the existing septic system, and the future <br />septic system replacement area. / <br /> <br />I further ¢~rtify that I have, to the best of my abilities, <br />inspected the septic system and found no evidence of any failure. <br />appears to be functioning in a satisfactory manner at this time. . <br /> <br /> (pr perry owfi~r Or~uthoriz~d agent) ' <br /> <br />Xailin9 lddrsss: ~/]~O ~'~f~V~¢4~ ~ <br /> <br />thoroughly <br />The syste~ <br /> <br />Mcl~-$3B <br />Rev 2/93 <br /> <br /> <br />