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AUTHORIZATION NOTICE <br />(Suppleme~tai Form) <br /> <br />IninformationOrder to properlYwill be necessary:eValuate Four existing sewage system, the fello~zing <br /> <br /> have an approved record of the system, we can proceed without <br /> any further action on your part. <br /> <br /> 2. If your sewage system is less than five ($) years old, and we <br /> do not have a record of an approved installation of the system: <br /> <br /> If your sewage system is more than five (5) years old or has no~ <br /> been pumped within the last five Fears: <br /> <br /> a. You must have the septic tank pumped. <br /> b. Have the septic tank pumper complete the form below. <br /> C. A field visit will be required by the Sanitarian to <br /> verify the location and condition of the septic system. <br /> d. If you have proof that your septic tank has been <br /> pumped within the last five (5) years, sections a & b <br /> will not be required. <br /> <br /> -For Septic Tank Pumper Use Only- <br /> <br />PROPERTY OWNER: PURDY R~AL ESTATE BROKER FOR U.S. MARSHALS 8F~VIC= <br /> <br />ADDRESS WHERE TANK PUMPED: 8991 Edcliff Ct. I,E. Aumsville~ Ore. <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />IS TANK IN GOOD CONDZTION? <br /> <br />ARE BAFFLES OR ~LBOWS IN PLACE? <br /> <br />ZS DRAINFIBLD BACKING UP INTO TANK? <br /> <br />gallons <br />~YES; NO <br />~ Y~S; NO <br />YES; ~NO <br /> <br />If yes, explain; <br /> <br />DIAGRAm] OF HOUSE AND <br />LOCATION OF I'ANK: <br /> <br />EXA~P L~ : <br /> <br />6'~ Septic Tank <br /> <br />Rev. 2/86 <br />cmb <br /> <br /> <br />