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AUTHORIZATION NOTICE <br /> (Supplemental Form) <br /> <br />~u order to properly evaluate your existing sewage sFstem, the following <br />information will be necessary: <br /> <br />have an approved reco~d of the system, we can proceed wit~t~ ~ <br />any further action on your part. ~ ~ <br />If your sewage system is less than five (5) years old, an~3e <br />do not have a record of an approved installation of the system: <br /> <br />If your sewage system is more than five ($) years old or has ~9~ <br />been pumped within the last five years: <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) ~ears, sections a ~ ~ <br /> ~ill net be required. <br /> <br /> -For Septic Tank Pumper Use Only- <br /> <br /> SZaW Sgp=IC galZons <br />ZS T~K XN GOOD CONDZTZONP ~YES; NO <br /> <br />ARE BAFF~S OR ELBOWS IN P&ACE? ~ YES; <br /> <br />IS DRAINFIE~U BACKZ~S UP INTO TANK? ~ YES; ~. NO <br /> <br />DIAGRAM OF HOUSE AND <br />LOCATION OF TANK: <br /> <br />EXAMPLE: <br /> <br /> 6'~ Septic Tank <br />t22'- <br /> <br /> .Ttreet <br /> <br /> <br />