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<br />AUTHORIZATION NOTIC~ <br />(Suppleme~tal Form) <br /> <br />10 orðer to prop~rly evAluate your ~~istin9 SeWAge system, <br />information will be necessary: <br /> <br />"-he follOwing <br /> <br />2. <br /> <br />If your sewage system is le.. thðn tive (five) years 014, an4 we\have <br />an approved record ot the system, We can proeeed without any tur~lIer <br />action on your part. <br /> <br />If your .ewage system ia less than five (5) years old., and we do not <br />have a record of an approVed 1nstallation of the .ystem: <br />or; <br />If your sewage system is More than five (5) years old Or hAs not been <br />pumper within the last !iveyears: <br /> <br />1. <br /> <br />a. <br />b. <br />c. <br /> <br />You must have the ..ptic tank pumped, <br />Rave the septic tank pumper complete loll. form below. <br />A field visit will be req\1ired. by the Senitaraian to verify the <br />location a~d condition ot the ..ptic system. <br />If you have proof that your septic tank has been pumped within the <br />last five (5) year., 8ections a 6 b will not be required. <br /> <br />d. <br /> <br />_Ma~¥a._---.M.____.-_._-----~-...__..__._._-_._._.__...--.---..--.-.____.œ_- <br /> <br />For Septic'Tank Pumper U.~ <br />COMPANY NAMEI4("E ~,....~~ ;::;'..4,,"".- <br />PitOPERTY OWNERI L'1/p ~r+ <br />ADDRESS WHERE TANK PUMi'ßO: Øoi Z- >41"- <br />< "l?~ :+ of <br />APPROXJ:MATE SIZ¡¡: OF SEP'1'J:C TA~K.' ')';O'dol <br />IS TA~K J:N GOOD CONDJ:TJ:ON? <br /> <br />Only <br />DEO LICENSE Nol~)7c1~~ <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br />IS DRAINFIELD BACKING UP INTO: TANK? , <br /> <br />9611ons <br />!\( YES <br />)t YES ; <br /> <br />NO <br /> <br />NO <br /> <br />YES, <br /> <br />t< <br /> <br />NO <br /> <br />It yes. explain; <br />SEPTIC TANK MATERIAL: Concrete <br /> <br />Steel <br /> <br />t< <br /> <br />Other <br /> <br />pIAÇt'W( OF HOUSE .uíD <br />LOCATION OF 'tANJ;: <br /> <br />N <br /> <br />" <br /> <br />EXAHPUt <br /> <br /> <br />" septic T.n1c <br />" <br />22'" X <br />well <br /> o~ <br /> <br />w <br /> <br />1::1 <br /> <br />3/82 ReV 10/97 <br />car <br /> <br /> <br />s <br /> <br />Sic;NATURE Of' <br /> <br /> <br />""",,,. <br />