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NAME: <br /> <br />AD DRESS: <br /> <br />TAX LOT NO: <br /> <br />SITE EVALUATION <br />FILE NO: <br /> <br />SYSTEM MUST BE INSTALLED AS SMOWN: <br /> <br />This document Is a geohnical repor~ for on-site sewage disposal only, lc r~ay be convertmd <br />Co s permit o~ly if, at the time of appltcagion, the parcel has been found to be compatible <br /> <br /> s~T~..., [~~ <br /> <br />The proposed site of ~he sewage sys=em installation ham been reviewed and approved By the <br />Marion County Sanitarian. <br /> <br /> PERMIT NO: . . . <br /> DATE;.~ <br /> <br />This pe~mi~ expires one year fromm date. <br /> <br /> <br />