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a, ion Co, nty <br /> OREGON <br />COMMUNITY DEVELOPMENT <br />DEPA R'I-ME N'I' <br /> <br />PROPERTY O~NER: <br /> <br />SIT~ ADDRESS: <br /> <br />SITE NUHBER: <br /> <br />I , hereby, certify that the attached site plan is an accurate <br />representation of the conditions on the above described property, <br />and that any proposed's~ru~ture/property division, meets all of <br />the minimum setback requirements from the existing septic system, <br />and the future septic system replacement area. <br /> <br />f 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 /> (proper~y owner/aUthOrized agent) · <br /> _ <br /> <br /> ,Xl ~..,,,,-,. ~ c, t1~_ .... ~'z' <- "~'-?3b~. ~'- <br /> <br />~C15-$38 <br />~LEV 3/93 <br /> <br /> <br />