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flAbik MARION COUNTY PUBLIC WORKS <br /> • <br /> �-15' te.. <br /> ECELIVE <br /> BUILDING INSPECTION DIVISION" ®=�� 5155..Silverton RD NE U <br /> Salem OR 97305" J <br /> (503)588-5147 Fax(503)588-7948 APR O 2019 <br /> http:llwww.co.marion.or.us MARION COUNTY <br /> BUILDING INSPECTION <br /> SEPTIC SYSTEM CERTIFICATION for RECORD REVIEW <br /> PROPERTY OWNER: bcx,-c`N Z-o s , )`ttit*5 <br /> Sill,ADDRESS::. \ Avt vv\SNt \ &t-)T4-- <br /> DATE: <br /> }2, <br /> DATE: / I <br /> FILE.NUMBER: <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 stnzcture(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 best of myabilities,thoroughly inspected the septic"system and found <br /> no evidence of any failure. The"system appears to be functioning in,a satisfactory manner at This time. <br /> SIGNATURE: r <br /> 11 <br /> perty er or the:.Owner's Authorized;Agent) <br /> .1- 3 <br /> Name(please print): J Ott 8' 1611:15)1,-„ <br /> Company Naive: f <br /> Mailing Address: <br /> Phone Number:- '�O�' � C)-"�-) ) <br /> Gt1FOR1VIs1sEPTIC1S=38-:RRCerti$cationPinaldoc 5-38 Rev:.9/10,1/11. <br /> 3': E <br /> 1 - <br />