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Sectlos 1313 <br /> <br />SEPTIC SYS~ CRRTIFZCAT~ON <br /> <br />Whenever a building pez-mi~ applieatiop is eubmitted for an accessory structure <br />or alteration/addition where bedr~om~ (o~ eewage flows) aft not affected, and <br />there is an e×ia=ing stp=lc system, ghe <br /> . . applicant must complete the followlng <br />statement, This statement is to be ~tached to the application/permit. <br /> <br />~ROPERT¥ OWNER= <br /> <br />SITE ADDRESS: <br /> <br />SITE NUMaER= <br /> <br />~, hereby, certify that the attached isite plan is an accurat~ representation <br />of the conditions on my ~Operty, and that the pro~sed structure meets ali <br />minimum setbask remitments fr~ thai existing septic sy~=em, and the future <br />septic system replacement area. <br /> <br />I further certify that I have, to'~the best of my abilities, thoroughly <br />insetted the septic system and fou~no evidence at this ~ime. system <br />appears t° b~,fu/ioning in a saW, factory manne~ef 'any failure' The. <br />(pro~rty owner or author%~ age,t) / / <br />N~e (pleas. print): ~ ~ ,~/~SD~ <br /> <br />Rev 2/93 <br /> <br /> <br />