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SI", ADDRESS: <br /> <br />INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> /0£3~ ,4"/~,{,~.o X. //~ ; ~E~IT NO. ~ ?- <br /> <br />AS-BUILT PLAN OF CONSTRUCTED EYST~: <br /> scale: 1" = ~ ' <br /> <br />(show all details and dimensions necessary to locate all components of the system in the future) <br /> <br />Model: ~P~ ; Static Head in System: <br /> <br /> (for Marion County use only) <br /> The above septic system has been inspected by Marion County. The information has been determined <br /> to be accurate and the system is: <br /> [~ Approved f% <br /> [ ] Approve~-~/~co~re~ons:/~see inspection report <br /> [ ] Denied ~ // / ^~ // A / / ..~ , <br /> <br /> · <br /> Signed: Title: Date: 7'{0- <br />as-built.frm 4/95 WHITE:Marion County; YELLOW:Owner; PINK:Installer <br />MC-15-S41 <br /> <br /> <br />