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AUTHORIZATION NOTICE <br />($~$plemental form) <br /> <br />Zn o~der to properly evaluate your existing, sewage system, the following <br />information will be necessary: <br /> <br />rf your sewage s~$=em is les~sthan five (5) years old, and we <br />hav~ ~u~ approved recoFd of the system, we oan proceed without <br />anW further action on your p~r:, <br /> <br />If your sewag~ system is less than five (5) years old, and we <br />do no~t have a re~ord of an ap$=oved installation of the system: <br /> <br />~ w0ur sewage system is more th&u~ five (5) gears old or hR~ not <br />been p~ped within =he l~t <br /> <br />c. A field visit will be re~ired b9 the S~i=ari~ to <br /> veri~ =he locati~ ~ ~nditi~ ~f the seEliG swstem. <br />d. If Wou have pr~f ~hat 9our seBtic ~ h~ b~n <br /> p~6 wi~in the 1~= fi~ (S) ~ears. sections a & b <br /> will not be required. <br /> <br />COMPANY NAME: M/ke's SeDtic Servi.ce. Tnt DEQ LICENGE NO: 33519P-2 <br /> <br />PROPERTY OWNER: Robert & Rachel' Mus~ <br /> <br />ADDRESS WHERE TANK PUMPED: <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />IS TAN~ IN GOOD CONDZTION? <br /> <br />IS DRAINFIELD ~ACKING UP INTO TANK? <br /> <br />zf Wes, explain; <br /> <br />D~AGRA~ OF HOUSE AND <br />~OCATION OF TANK: <br /> <br />EXAMPLE: <br /> <br /> Sestic <br /> Tank <br /> 6 ' | <br />I22 ~' <br /> <br />gallons <br /> <br /> ~f~ES; NO <br /> <br /> <br />