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Marion Co.unty <br /> <br /> OREGON <br />COMMUNITY DEVELOPMENT <br />DEPARTMENT <br /> <br />SEPTIC SYSTEM CERTIFICATION <br /> <br />PROPERTY OWNER: <br /> <br />S~TE ADDRESS: <br /> <br />SZTE NUMBER: <br /> <br />I, hereby, certify that the attached site plan is an accurate <br />representation of the conditions on my .,property, a~d 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: DATE: (prop/~f~y o~r or'authorxzed ag~nt)~ <br />Name (please print): <br /> <br />Mailing Address: <br /> <br />MC15-S38 <br />Rev 2/93 <br /> <br />24 Hour Code~A~one 58~,7e~04 <br /> <br />(503) 588-5147 Senator Building <br /> <br /> <br />