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0N-SITE SEWAGE SYSTEM RECORD <br /> ~ (tO be completed by system installer) <br /> <br />SITE,~DD.RESS: . th ~ ~/~ ; PERMIT NO. <br /> <br />AS-B~'~LT PL4~N OF CONSTRUCTED SYSTEM: <br /> scale: 1" = ~;~ <br /> <br />North <br /> <br />II (s~l details. ~a~d d~mensions necessary to locate all components of the system in the future) <br /> <br /> Sep~ ~at' :~, *Mfg: SYSTEM INSTALLED AT THE A~0VE ADDRESS WAS CON- <br /> <br />Distribution; [ ] ~lrop / ~ Concrete; [ ] Plastic <br /> <br /> ~ ~odel~/ Static Head in System: <br /> ~p ~cle Time: ~5~ , Gallons per ~cle: <br /> <br /> (for Marion County use only) <br /> The above septic system has been inspected by Marion County. The information has been determined <br /> ~be accurat~ and the syste~ is: <br /> Appro~.~ <br /> [ ] Approv~with ~ections: see inspection repot <br /> [ ] Deni6d~ ~[ e.'~ <br /> Signed: ~/~ Titl /"/~---~ Date: <br />.s-built.fr~4~5 % WHITE:Marion County; YELLOW:Owner; P~NK:I~staller <br />MC- 15-S41 ~ <br /> <br /> <br />