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Marion County <br /> <br /> OREGON <br />COMMUNITY Dk-'v'ELOPM~-NT <br />DEPARTMENT' <br /> <br />SEPTIC SYS~F/~ CERTIPIOATION <br /> <br />PROPERTY OWNER: <br /> <br />S~TE ADDRESS: <br /> <br />SITE NUMBER: <br /> <br />I, hereby, certify that the attached site plan is an accurate <br />representation of the conditions on my .~roperty, ah'd that ghe <br />proposed structure meets all minimum setback requirements from <br />the existing septic system, and the future septic system replace- <br />ment area. <br /> <br />I further certify that I have, to the best of my abilities, <br />thoroughly inspected the septic system and found, no evidence of <br />any failure. The system appears to be functioning in a satisfac- <br />tory manner at this time. <br /> <br /> · (prop/~y O~er or'authorized aq~nt)~ <br />Name (please print): <br /> <br />Mailing Address: <br /> <br />MC15-$38 <br />Rev 2/93 <br /> <br /> <br />