HomeMy WebLinkAboutPermit Plans 1977-02-15*
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Subdivision Lot- Block
-FOR SANITARIAN'S USE ON LY: f, Syrt". Approved f,l System Disapproved tl Needs Correction
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Signature Zrg4-Date: ;2 4 f-77
RE0EIVL"-:FOR INSTALLER'S USE: Trench Depth ' l'l-' ' I . Fiiler Depth Betow
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INSTALLATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION
When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat-
isfactory completion of a subsurface sewage disposal system at the above location.
Return this form to: Permit Processing Section, Department of Environmental lVlanagement,
Public Service Building, 125 East 8th Avenue, Eugene 97401
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