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AUTHORIZATION NOTICE <br />(Supplemental Form) <br /> <br />· in order to properlg evaluate wour~xistin9 sewage system, the following <br /> i,~formation will be neoessarwz <br /> <br />have an approved Te~rd of the system, we can proceed w~thout <br />an~ f~r~her a¢tion on your part. <br /> <br /> 2. zf Fou~ s~¢age sF$tem ~s less than £~ve (5) ~ears old, and we <br /> do not have a record of an approved i~stallation of the swstem: <br /> <br /> If gout sewage s~stem is more than five {5) ~earS old or has act <br /> been pumped within the last five ~ears: <br /> <br /> a. You must h~ve ~he septlo tank p~mped. <br /> <br /> A field visit will be required bw ~he Sanitaria~ ~o <br /> verify the location and condit~on of ~he septic system. <br /> d. Zf ~ou have proof that your septic ~ank has been <br /> pumped within ~he last five (~) ~ears, sections a & b <br /> will not be required. <br /> <br /> -For Sep~tic Tank Pumper Use Only- <br /> <br />CO,WPANY NAME: S~a3ton Se~,~ic Service DE~ LZC~NSE NO: <br /> <br /> 10664 Silver Falls Hwy. ./ <br />ADDRESS WHERE TANK PUMPED: <br /> <br />34916 <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE BAFELE$ OR ELBOWS IN PLACE? <br /> <br />IS DRAtNF£ELD BACKING UP INTO TANK? <br /> <br />NO <br /> <br />If yeS, ~xplain; <br /> <br />DIAGRAm1 OF BOUSE AND <br />LOCATION OF TANK: <br /> <br />EXA~PLE: <br /> <br />I <br /> <br /> <br />