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SITE ADDRESS: <br /> <br />INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> <br /> ( <br /> <br />A~-BUiLT PLAN OF CONSTRUCTED SYSTEM: <br /> <br />North <br /> <br />(show all details and dimensions necessary <br /> <br />Size: /~ Mat'l:j~~ Mfg:~, <br />Distribution; ~ Drop / ~ Concrete; [ ] Plastic <br /> <br /> Pu~ ~cle Time: ~ : Gallons per ~cl~- <br /> <br />of the future) <br /> <br />DEQ License Nu~foer: <br /> <br />Company <br /> <br /> Date: <br /> <br /> (for Marion County use only) 4~, · - <br />The above septic system has been inspected by ,arion County. The informa~,O~ ~as~een ~.~ihed <br /> i,: i"i L-- -' <br /> ] Approved with ections: see inspection report <br />[ ] Deni, <br /> <br />Ti <br /> <br />MC15-$41 WHITE:Marion Co~ty; YELLOW:Owner; ?INK:Installer <br />Rev 4/98 <br /> <br /> <br />