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,Marion County <br /> <br /> OREGON <br />COMM UNI'I~ DEVELOPMI:N1- <br />DEPARTMENT <br /> <br />SEPTIC SYSTEM CERTIFICATION <br /> <br /> PROPERTY OWNER: <br /> <br />· S~TE ADDRESS: <br /> SITE NUMBER: <br /> <br />I, hereby, certify that the attached site plan is an accurate <br />representation of the conditions on my ·property, ~t,d that the <br />proposed structure meets all minimum setback requirements from <br />the existing septic system, and the future septic system replace- <br />ment area. <br /> <br />I further certify that I have, to the best of <br />thoroughly inspected the septic system and found <br />any failure. The system appears to be functioning <br />tory manner at this time. <br /> <br />SIGNATURE: ~~/,~_ <br /> (property~-~wne~-or authorized agent) <br /> <br /> my abilities, <br /> no evidence of <br /> in a satisfac- <br /> <br />DATE: <br /> <br />Name (please print): <br /> <br />Mailing Address: <br /> <br />MC15-S38 <br />Rev 2/93 <br /> <br />MARION COUNTY <br />BUILDING INSPECTION <br /> <br />24 Hour Code-A-Phone 5~7~04 <br /> <br />(503) 588-5147 Senator 8uiJding <br /> (503) 588-7948 220 High St. NE · Salem, OR 97301-3670 <br /> <br /> <br />