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SEWAGE SYSTEM CERTIPICATION Add...ress
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,rty O..ner +d'-'- I ke ContractorJ)o,,;s: B-,,k-'hce .Sen•ce /Scale: 1 Square = 10'
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Date M"'{ I.? Parcel# L ,..f r� ... --
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Draw in physical structu_res to be on lot. . Show location of well or ap.y body of ;,;ater. /. Show location of septic sys""� in relationship to structu..re. ;· ·�.- ··•-<;�.•, ""''. .•, = .. , ••=• & -�" eleva�ions in re.1.a�1on to 1t. 6. Use ft_rrows to show direction of slope. ,,.r� "II 100' \.
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I certify that this system is installed as shokn above, arid that a1i! requirements arid staridards of Thurston-!·!ason Health District have , been satisfied. Signa�� e_ �1 Contractor's License # -2.:l,S -b.J. - 9-l?/
Jun!,�/J�
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