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, filookk. , UAgiori•cCou:Nry:PUBLIC WORKs <br /> MaDINQINSFECTIONDIVISION <br /> ......,—...-...-;....-_-_-__•.-->->.-----c--.L.,...,-i._•1 5155 Silverton RD NE <br /> $4101 OR 97305. <br /> (503)588=5147 Fax(504 588=7948 <br /> httri://wwW.ca,mation.tir,us <br /> SEPTIC SYSTEM CERTIFICATION Tor RECORD. REVIEW <br /> PROPERTY OWNER: ketti,11- Ygl _.. I(*kg S.E to' <br /> srrtADDRtss: ioetqg 's v --- ( 6 <br /> - od ay^ eR- q2eY7 i <br /> DATE: <br /> FILE NUMBER: 556-- 11- CP'371(-/4, • <br /> •.*: . <br /> I Certify that I,have personally investigated the exiSting septic system on the above property and have, <br /> identified the exact location of all parts of the septic system, including the septic tank, distribution box <br /> or drop boxes, drainfield lines.and,future septic system replacement area. The attached site plan is an <br /> accurate'representation of the location of the septic system and proposed structure(s).on the property, <br /> and the proposed development meets all minimum setback requirements from the existing septic <br /> system,and the future.septic system replacement area. In addition if there isn't a septic system serving <br /> the property;this document Is to certify that a full investigation has been made to determine that the <br /> parcel is not being served by a septic system. <br /> I further certify that,I have,to the hest of my abilities,thoroughly inspected the septic systentand found <br /> no evidence of any failure. The system appears to be functioning in a satisfactory mannerat this time. <br /> SIGNATURE: 'W.-,-L-tA', ' . <br /> • (Ptiopertf owner or the Owner's Authorized Agent). <br /> .Name(please printr:'. vt,0 Yen ..: v%..l .IAN - <br /> COinPATIY Nallid: KFAY-Aets .—Tel • <br /> ' <br /> Mailing Address:: 1 G.99 A, ey-,‘„aot. Leek 1).a.- <br /> 60c5teck) ,o,e.. 97011 <br /> PhoneNinnherz ".03- &72-3'1,45' <br /> G:WORMS\SEPTIC\S-18RR.CertifkaticinFinabioe <br /> S-38 key: WIC;1111 <br />[ <br />