PLEASE READ BEFORE SIGNING:
PLEASE READ BEFORE SIGNING: The terms “you,” “your,” and “yours,” where contained below, apply to all applicants for the Residential Wildfire Septic Recovery Joint Grant Application with MWVCOG and Marion County Building Inspection.
You are submitting this application jointly to the MWVCOG and Marion County Building Inspection. You certify that this application is true and complete. MWVCOG and Marion County Building Inspection may verify this information from whichever sources it deems necessary and may provide others with information regarding your application information with MWVCOG and Marion County Building Inspection to the extent permitted by law. This application remains the property of the MWVCOG and Marion County Building Inspection.
By signing this application, I attest to the following:
“I agree that Santiam Disaster Services and your Disaster Case Manager can release information to MWVCOG/Marion County, and that MWVCOG/Marion County may share all information about your On-Site Septic Application with Santiam Disaster Services and your Disaster Case Manager.”
• The property referenced above was affected by the Labor Day fires in 2020 and the residential septic had to be repaired, replaced or otherwise modified as a result.
• The information contained in this form is accurate.
• I have not received, and do not anticipate receiving, assistance from insurance settlements, FEMA assistance, or any other state, local, federal, or private assistance for the repair or replacement of a septic system that, when combined with this grant program, would exceed the actual costs for eligible expenses incurred.
Further by signing this application, I agree to the following:
• I agree to transition my septic system to a future sewer system once the system is installed.
• I agree that the future sewer system, to the extent practicable, may use components of my septic system receiving a reimbursement grant.
I hereby declare that the above statements are true to the best of my knowledge and belief, and that I understand they are subject to penalty for perjury.