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SITE~ADDRESS: <br /> <br />INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> <br />AS-BUILT PLAN OF CONSTRUCTED SYST~: <br /> <br />scale: 1" = <br /> <br /> ! <br />North <br /> <br />(show all details and dimensions necessary to locate all components of the system in the future) <br /> <br />Signed: <br /> <br />Company name: <br />(please print) <br /> <br /> D.te: <br /> <br /> (£or Marion County use only) <br />The above septic system has been inspected by Marion County, The information has been <br /> <br />[ ] Appro~f~ corre~.i..obs: ~ee inspection <br />Sig]%ed: ~V ~ <br /> <br />report <br /> <br />~, ,7/g/~ JUL 0 6 1999~/ <br /> <br /> <br />