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INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> /~ ~ ~/ (to be completed by system installer) <br />SiTE ~DR~SS: ~ ~--'~0.,~,~ ©~,, "~'~-'~';Ik ~ ~E~IT ~0.~ <br /> / <br />AS-BUILT pLAN OF CONSTRUCTED SYSTEM: <br /> <br /> ~J~L <br /> ~.~ ~'~~_ ~j&~ON COUNTY <br /> ~,~' ~ ' '~,~ <br /> <br />(show all details and dimensions necessary to locate all components of the system in the future) <br />~x(es): [ ] Distribution; [ ] Drop / [ ] Concrete; [ ] Plastic <br /> <br />T~ D.~, Mini~m: ; Maximum: ; ~rtain Drain D.pth:~ Si~ed: ~ <br /> (please print) <br /> <br />MC-15-S41 <br /> <br /> (for Marion County use only) <br />The above septic system has been inspectad by Marion County. The information has been determined <br />to be accurate and the system is:l~]Appr°ved F/L ~ <br /> Approved with ections: see inspection report <br />[ ] Denied <br /> Title~~~z Date: ~~ <br /> WHITE :Marion County; YELLOW: Owner; PINK: Installer <br /> <br /> <br />