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, INDIVIDUAL ON-SITE SEWAGE SYSTEM <br /> ~ (to be completed b~.system installer) <br /> \ <br /> SITE ADDRESS: --~T~ 3~O~l~&.~; ~.7~6~%~ ; PERMIT NO. <br /> <br />AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> scale: 1" = ~ ' <br /> <br />RECORD <br /> <br />North <br /> <br />(show all details and dimensions necessary to locate all components of the system in the future) <br /> <br />size: .~ Met'l: ~ON~- <br /> <br /> Distribution; [ ] Drop / [~Concrete; [ ] Plastic <br /> <br /> I 0 <br /> <br /> Minimum: ~t; M~ximum: ~;' Curtain Drain <br /> <br />(please print) <br /> <br /> The above septic system has been inspected by Marion County. The inform ' h be ~termined <br /> to be accurate and the system is: <br /> [~ Approved <br /> ~ ] Approved with corrections: see inspection report <br /> <br /> Signe~:~/// Titl Date: {6) <br />as-buil~.frm 4/95 ' WHITE:Marion County; YELLOW:Owner; PINK:Tnstaller <br />MC-15-S41 <br /> <br /> <br />