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SITE ADDRESS: <br /> <br />AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> <br /> scale: 1" = ' <br /> <br />INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to b~completed by system installer) <br /> <br /> ! <br />North <br /> <br />(show all details and dimensions necessary to locate all components of the system in the future) <br /> <br />Distribution; [ ] Drop / [ ] Concrete; ~ ] Plastic <br /> <br />[~'~icensed Sewage Disposal Service <br /> <br />Company name :~'~ <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 to be accurate and <br /> <br />th system is: <br />~Approved <br />[ ] Approved with corrections: see inspection report <br />[ ]~Denied <br /> <br /> Signed: <br />Rev 4/98 <br /> <br />Title: ~ <br /> WH~T~:Marion County; YELL : ; ~INK:[nstaller <br /> <br /> <br />