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MARION COUNTY PUBLIC WORKS <br /> mar- - BUILDING INSPECTION DIVISION <br /> 5155 Silverton RD NE <br /> Salem 05 <br /> Fa (5 <br /> (503) 588-5147 Fax(503) 588-7948 <br /> http://www.co.marion.or.us <br /> SEPTIC SYSTEM CERTIFICATION for RECORD REVIEW <br /> PROPERTY OWNER: szbid_tar \gq,etiA- .K ,.,q. <br /> S1IE,ADDRESS: a 3 5 3 `f 43A .ie,,,•,,_ cV <br /> $ : &e37 5 <br /> DALE: o2-lv- aol () <br /> FILENUMBER: 044 i; -o(7� ----- -- <br /> ‘53- - 1e -o0o993 - r_,tloy <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 best of my abilities,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: itt.u.2(peb <br /> (Property Owne}%the Owner's Authorized Agent) <br /> Name(please print): \jn i p y-,i n <br /> Company Name: N/A J <br /> Mailing Address: ?C yrx sic't ) ?lain (`R cin_37 R <br /> Phone Number: 503 - 5 9 - a 3 5�. <br /> G'.\FORMS\SEPTIC\S-38 RRCerbfcelioaFinal doe S-38 Rev 9/I0,1/11 <br />