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Marion County <br /> <br /> OREGON <br />COMMUNITY D~VELOPMENT <br />DEPARTMI=NT <br /> <br />SEPTIC SYSTEM CERTIFICATION <br /> <br />PROPERTY OWNER: <br /> <br />S~TE 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 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: ~ . , <br /> (property owner or authorized agent) <br /> <br />Name (please print): J//~ ~?%$Ce 9a ~Z~/~e%'~ e. <br />Mailing Address: <br /> <br />MC15-S38 <br />Rev 2/93 <br /> <br />24 Hour Code-A-phone <br /> <br />(503) 588-5147 s~.ato~ ~d~di~g <br />~^× (503) 588-7948 220 j{J~h St. NE · Salem, OR 9730 -3670 <br /> <br /> <br />