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OWNER: <br />ADDRESS: <br />INSTALLER: <br />SEPTIC TANK: <br /> <br />CERTIFICATE OF SATISFACTORY COMPLETION <br /> <br /> MARION COUNTY <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />BUILDING INSPECTION DiVISiON <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> PHONE: 588-5147 <br /> <br />_.~q ON-SITEr SEWAGE SYSTEM INSTALLATION INSPECTION <br /> t'(~ ~.)~_l~,..~ ............. SITE NO. '¢,~' ~)~2-¢?~/ <br /> <br /> NO, GALLONS: /oOO <br /> MATERIAL: ~,~c P..C-c"~-- <br /> MANUFACTURER: <br /> <br />BUILDING SEWER MAT'L: <br />EFFLUENT SEWER MAT'L: <br />COMMENTS: <br /> <br />PERMIT NO, ,, <br />DISPOSAL FIELD: <br /> TOTAL LENGTH: .... <br /> PIPE MAT'L: <br /> TRENCH DEPTH: <br /> ROCK DEPTH: <br /> DIST, 'TO WELL: <br /> BOXES: <br /> <br />in accordance with Oregon Revised Statut, e 454~86~;i"illis certificate is issued as evidence of Sati~'i~ct(~ry <br /> <br />iNSPECTED BY: <br /> TITLE:- <br /> <br /> <br />