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~CBI POLICY~PROCEDUR~ <br /> <br />SEPTIC SYSTEM CERTIFICATION <br /> <br />- Procedure - <br /> <br />Section 1313 <br /> <br />Whenever a building permit application is submitted for an accessory structure <br />or alteration/addition where bedrooms (or sewage flows) are not affected, and <br />there is an existing septic system, the applicant must complete the following <br />statement. This statement is to be attached to the application/permit. <br /> <br />PROPERTY OWNER: <br /> <br />SITE ADDRESS: <br /> <br />SITE NUMBER: <br /> <br />I, hereby, certify that the attached site plan is an accurate representation <br />of the conditions on my property, and that the proposed structure meets all <br />minimum setback requirements from the existing septic system, and the future <br />septic system replacement area. <br /> <br />I further certify that I have, to the best of my abilities, thoroughly <br />inspected the septic system and found no evidence of any failure. The system <br />appears to be f~ncti~oning in a ~atisf~ry manner at this time~ ! <br /> <br />SIGNATURE: ~ffope~ty oWffef or/ut"n'oriz~3~agent) DATE: <br /> <br />Name (please print): <br /> <br />Mailing Address: <br /> <br />Mc15-S38 <br />Rev 2/93 <br /> <br />MARION CO;J~jT'¥ <br /> <br />9/O9- '11(~9.1~1Q9.191(~9.91(~I j~Q <br /> <br /> <br />