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Marion County <br /> <br /> OREGON <br />COMMUN[TY DEVELOPMENT <br />DEPARTMENT <br /> <br />SEPTIC SYSTEM CERTIFICATION <br /> <br />PROPERTY OWNER: <br /> <br />SITE ADDRESS: <br /> <br />SITE NUMBER: <br /> <br />PERMIT NUMBER: <br /> <br />I, hereby, certify that the attached site plan is an accurate <br />representation of the conditions on my property, and that the <br />proposed structure meets all minimum setback requirements from <br />the existing septic system, and the future septic system replace- <br />ment area. <br /> <br />I further certify that I have, to the best of my abilities, <br />thoroughly inspected tt~e septic system and found no evidence of <br />any failtlre. The system appears to be functioning in a satisfac- <br />tory manner at this time. <br /> <br />SIGNATURE: ~r~r ~ 6~r or a~thorJ~z~d~&gent)'~ <br />Name (please print): <br />Mailing Address: <br /> <br />DATE: <br /> <br />MC15-S38 <br />Rev 2/93 <br /> <br />24 Hour Code-A-Phone 5~-7~d4 <br /> <br />(503) 588-5147 Senalor 8uildi~8 <br />~^x (503) 588-7948 220 HLgh SI. NE , Salem, OR 97301-3670 <br /> <br /> <br />