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II DIVIDUAL ON-SITE SEWAGE SYSTEM <br /> (tO be completed by system installer) <br /> <br />RECORD <br /> <br />SITE ADDRESS: 35/ '/~ = ~/ ..' <br /> <br />AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> <br />· PERMIT NO. ~- 0¢7~ <br /> <br />NIAI:{ION COUNTy <br />BUILDING INSPECT/ON <br /> <br />North <br /> <br />7R' <br /> <br />(show all details and dimensions necessary to locate all components of the system in the future) <br /> <br /> (for Marion County use only) <br /> The above septic system has been inspected by Marion County. The informaticn has been determined <br /> to be accurate and the system is: <br /> [~ Approved <br /> Approved with corrections: see inspection leport <br /> <br />as-built.frm 4/95 WHITE:Marion County; YELLOW:Owner; ~NK:Installer <br /> <br /> <br />