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ZNDIVIDUAL ON-SITE ·SEWAGE <br /> {kO be completed by sy~"em <br /> <br />sYSTEM"RECORD <br /> <br />PERMIT NO. <br /> <br />all dot:ails and dimen$ion~ necessary to looa=e ail components Of the ~yntem in the 'future) <br /> <br />Septic Tank: size:,.,,,,~ ,, <br /> <br />Distribution Pip~:Siza:. ~/' , ., <br /> Material: ~ ~~ . <br />~rain M~dj, a: Depth <br /> <br /> I MEREBY CERTtFY',T~T'··TH~ 0N-SIT~ SEWAGE <br /> <br />STRUCTED IN ACCORD~CE WIT~ T~E 2~QUIRE~ENTS 0~:' <br />TM~ PE~IT ~D T~{~ RULES 0F T~[~ ~NVI~%ONMENTAI, <br /> <br /> [ 1"' ~ ~v~, =e~ed..the."~&p~,}c eank and <br /> <br />com~any,Datename ~: ~' ~ ~ · <br /> <br /> (for Marion COU~y use only) , :. .... . ' , <br /> <br />Th~ above septic ~ystem ha$ bell% inspected by Mario~ County, The inf~ma~i0~ has been <br /> <br />[ ~ Approved , . <br />( I o~mled ' "' ' "' <br /> <br /> <br />