Laserfiche WebLink
INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be by system installer) <br />SITE ADDRESS :~ ~ <br /> __; PERMIT NO. <br /> <br />AS-BUILT PLAR OF CONSTRUCTED SYST~: <br /> <br />scale: l" = __' ~.~ ~ <br /> <br />North <br /> <br />(show all details and dimensions necessary to locate all com)onents of the system in the future) <br /> <br /> I HEREBY CERTIFY T~AT THE ON-SITE SEWAGE <br />SYSTEM INSTALLED AT THEABOVEADDRESS WAS CON- <br />STRUCTED IN ACCORDANCE WITH TSE REQUIREMENTS OF <br />THE PERMIT AND THE RULES OF T~E ENVIRONMENTAL <br />QUALITY C0EMISSION. <br /> [ ] I have tested the septic tank and certify <br /> it to be watertight. <br /> <br />The system was installed by: <br />Property Owner (permitee) <br /> Licensed Sewage Disposal Service <br /> <br />Signed: <br /> <br />(please print) <br /> <br /> (for Marion County use only) <br /> The above septic system has been inspected by Marion County. The informat: <br /> the system is: <br /> ~Approved <br /> [ ] Appro~corr~ons: see inspection report <br /> [] Denied <br />~~Signed: <br />Rev 4/98 <br /> <br /> ~t'~/~ ~as been determined to be accurate and <br />~ Date: <br /> WHITE:Marion County; YELLO~~ <br /> <br /> <br />