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SiTE ADDRESS: <br /> <br />AS-DUILT PLA/q OF CONSTRUCTED SYST~: <br /> <br />INDIVIDUAL ON-SITE SEWAGE SYSTEM <br /> (to be completed by system instal]er) <br /> <br />RECORD <br /> <br />__, P~RMIT NO,~-- /~072~ <br /> <br />North <br /> <br /> (show all details and dimensions necessary to <br /> <br /> , <br />~a~(,as)~ i I Di~%~%k~ion; [~ DroD [ ~Conereee; { 1::~ <br /> . ~'1+~ c~.~s ,, ~r~, ,, <br /> l~' ' <br /> <br />oeate all Components of ~he sysge~ in the~,,,, future) <br /> <br />SYSTEM INSTALLED AT T~ A~OV~ ADDRESS W~ CON- <br /> <br /> (for Marion ~ounty us~ only) <br /> The above septic system has been i~spee~ed by M~rion Co=nty. The information has been determined <br /> to be accurate and the system is: I <br /> [ ] Approved <br /> [ ] Approved with corrections: see i~spection r~port <br /> [ ] Denied i <br /> <br /> $igned~ Ti~ie: Date: <br />~s-built.frm'4/95 WMI~E:Marlon County; YELLOW,Owner; P/NK:ins~al er <br />MC-15-S41 <br /> <br /> <br />