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Permit - 1299396
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Permit - 1299396
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Entry Properties
Last modified
7/11/2011 12:05:33 PM
Creation date
9/4/2003 2:34:08 PM
Metadata
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Template:
Permits
Permit Address
10664 SILVER FALLS HY SE
Permit City
Aumsville
Parcel Number
081W17C 00300
Permit Type
Permit
Permit Site Number
1125
Permit Doc Type
Permit Document
Status
Ready to Film
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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 />
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