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Marion County Building Inspection <br />3150 Lancaster Dr NE - Suite C <br />Salem, Oregon 97305-1398 <br /> <br />Pl-Ig 588-5147 <br />FAX~ 588-7948 <br /> <br />SEPTIC SYSTEM CERTIFICATION <br /> <br />PROPERTY OWNER: <br /> <br />SITE ADDRESS: <br /> <br />ACTIVITY NUMBER: <br /> <br />I certify that I have personally investigatexl the existing septic system on the above , and <br />have identified the exact location of ail parts of the septic system, septic tank, <br />distribution box or drop boxes, dminfield lines and future septic The <br />attached site plan is an accurate representation of the location of the and <br />structure(s) on the property, and the proposed development meets uire- <br />·ments from the existing septic system, and the future <br /> <br />I further certify that I have, to the best of my abilities. <br />found no evidence of any failure. The system appears to be <br />at this time. <br /> <br /> septic system and <br />in a satisfactory manner <br /> <br />SIGNATURE: <br /> <br />Name (please print): <br /> <br />Company Name: <br /> <br />Mailing Address: <br /> <br />Date: <br /> <br />MCI5-S3g <br />REV 6,'98 <br /> <br />(licensed s~tic installer <br /> <br /> JUL 2/ 998 <br />MARION COUNTY <br />BUILDING I[4SPECTION <br /> <br /> <br />