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AUTHORIZATION NOTICE [/ ~ <br />(Supplemental Form) ~,.z~_ ~-~._~3-~.-f~ ?>~' ?i ~.~ <br /> <br />tn order to properly evaluate your existing sewage system, the following <br />information will be necessary: <br /> <br />If your sewage system is less than five (5) y~ars old, and we <br />have a record of the system, we can proceed without any further <br />ac~ien on your part- <br /> <br />2. If your sewage system is more than five (5) years old or we <br /> do Rot have a record of the system: <br /> <br />a. It will be necessary to have the septic tank pumped. <br />b. Have the septic tank pumper complete the form below. <br />c. A field visit wilt be require~ by the Sanitarian to <br /> verify the location and condition of the septic system. <br />d. If you have proof that your septic tank has been <br /> pumped within the last five(5) years, sections a & b <br /> above will not be required. <br /> <br />For Septic Tank Pumper Use Only - <br /> <br />PROPERTY OWNER: ,,~.,~,..~*~,,~-;, ,,, <br /> <br />ADDRESS WI{ERE TANK PUMPED: %%4~(? <br /> <br />DEQ LICENSE <br /> <br />3/82 <br /> <br />APPROXIMATE SIZE OF S~FTIC <br /> <br />Is TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />0IAGRAM OF ~0USE AND <br /> LOCATION OF TANK: <br /> <br />EXAMPLE: <br /> <br />Septic tank <br /> <br />NO <br /> <br />zen,. o./ Lix t <br /> <br /> <br />