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INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> [to be complebed by sys~em~ installer) <br />~=~ ~D~: IO~('~ t~d~Crce{< ~1. SA., A,~-oil~e , ~ ~o. q7--05Z03 <br /> <br /> scale: 1" = ~ ' <br /> <br />,o% ~ <br /> <br />(show all details and dimensions necessary to locate all components of the system <br /> <br /> , .ST _-- t~TXPiC~T~ ~l <br /> I HEREBY CESTIFY THAT THE ON-SITE SEWAGE <br />SYSTEM INSTALLED AT T~E ABOV~ ADDRESS WA~ CON- <br />STHUCT~D IN ACCORDANCE WITH THE R~QUIP~S OF <br />THE PERMIT AND TH~ RULES OF THE SNVIRONM~AL <br /> <br />The system was £nstmlled by: <br />[ ] Properuy Owner (permitee] <br />~ Licensed Sewage Disposal <br /> <br />(pleaSe p <br /> <br /> (for Marion County use only) <br /> The above septic system has been inspected by Marion County. The information has been determined <br /> t~be accura=e~-~.nd the system is: <br /> [~ Approved | \ --~ ~ <br /> [ ] Approved W~t~ ~re~t~: se~D~On report ~ <br /> <br /> T~tle Date ~ <br />MC-15-S41 <br /> <br /> <br />