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AUTHORIZATION NOTICB <br /> (Supplemental Fo~m) <br /> <br />Xn drder t~ pr~$erlW evaluate ~our existing sewage s~stem, th~ follOWing <br />i~formation will be necessary: <br /> <br />If ~eur sewage S~=tem is:less than five (5) gears old, and we <br />have an approved recor~ of the ~stem, we can procee~ without <br />ang further action on ~our p~rt. <br /> <br />If ~eur sewage SgStem is les__s than five (~) ~earS 01~. and we <br />do no~thave a record of an approved installation of the <br /> <br />If ~our sewage sUstem ~$ .~ore th~ five (5) ~ear$ old or has not <br />bee~ pumped w~thin the last five ~ears: <br /> You must have the s~ptlc tank pumped. <br /> Have the septic tz~kpumper ~omplete the form below. <br />c. A field visit will be required bg the Sanitarian <br /> ver~fg the location and =ondition ef the septic $~stem. <br /> If ~ou have proof ~hat ~o~r =~ptic ~ank has bee~ <br /> pumped within the last five (S) ~ears, sections a & b <br /> will not be required. <br /> <br /> -For Septic Tank Pumper Use Onlu- <br /> <br />COMPANY NAME: Mike '$ Septic Service. <br /> <br />PROPERTY' OWNER: Pat Music <br /> <br />Inc <br /> <br />DEQ LrC~NS~ No: 33519P.~ <br /> <br />~DDRESS WNERE TANK PUMPED: <br /> <br />5721 Village View <br /> <br />. Aumsvi~le 0reqon <br /> <br />APPROX~AI'E SIZE OF $EPTIC <br /> <br />IS TANK fN ~OOD <br /> <br />IS D~NFIELD BACKING <br />If HeS, explain; <br /> <br />DrACRAM OF HOUS~ AND <br />LOCATION OF <br /> <br />E XAMP L~ = <br /> <br />Septic <br /> <br />Rev. ~/$6 <br /> <br />~allmn$ <br />YES; NO <br />X~_Y~S; NO <br /> <br /> <br />