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SITE ADDRESS: <br /> <br /> INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> <br />AS-B~LT P~ O~ CONSTRUCTED SYSTEM: <br /> <br /> scale: -- -~ <br /> -~ ' North <br /> <br /> (show all details and dimensions necessary to locate all components of the system in the future) <br /> <br /> Senti= T~= Size: ~ ~ ~ Mat'l: ~/~ Mfg, ~ SYSTEM INSTALLED AT THE ~O~ ~DRESS W~ CON- <br /> <br /> (for Marion County use only) <br />The above septic system has been inspected by Marion County. The information has been determined <br /> <br /> to be accurate and the system is: <br /> ~ Approwed <br /> [ ] Appr3~a~ with~rrections: <br /> <br />as-built.fr~9g - ~ <br /> <br />see inspection report <br /> Title, ~~; ~.-~-~_ Date: <br /> WHITE :Marion County; YELLOW:Owner; ~IIK: I~staller <br /> <br /> <br />