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ar ,,on c, ount <br /> <br /> OREGON <br />COMMUN]TY Dk-VELOPMENT <br />DEPARTMENT <br /> <br /> PROPERTY OWNER: <br /> <br />. SiTE ADDRESS: <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 />I further certify that I have, to the best of my abilities, <br />thoroughly inspected the septic system and found no evidence of <br />any failure. The system appears to be functioning in a satisfac- <br />tory manner at this time. <br /> <br />SIGNATURE: / ' DATE: <br /> ~proper~~ <br />Name (please print): /~?~'~ /~/~-'~ -- <br /> <br />MC15-$38 <br />Rev 2/93 <br /> <br /> <br />