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INDIVIDUAL ON-SITE SEWAGE <br /> (to be completed by system installer) <br /> <br /> ~ITE ADDRESS: <br /> <br />AS-BUILT ~LAN OF CONSTRUCTED SYSTEM: <br /> <br />scale: 1" = <br /> <br />SYSTEM RECORD <br /> <br />Size: '/ Ma~' 1: / <br /> <br /> Distribution; [~ / [~ncrete; [ ] Plastic <br /> <br /> ~xi~m: ~ ; ~ain Drain <br /> <br />Company <br />(please print) <br /> <br /> (for Marion County use only) <br /> The above septic system has been inspected by Marion County. The information has been determined <br /> tp.be accurate and the system is: <br /> [%(~Approved~--~ ~ <br /> [ ] Approved~wi~h/'~orr~ct~o~s: s~ inspection report <br /> <br /> Signed: Title:~ Date:~ <br />as-bum 95 ~ITE:Marion County; YELLOW:O~er; PINK:Inst~ler <br />MC-15-S41 <br /> <br /> <br />