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AUTHORIZATION NOTIC~ <br />(Supple/aental Form} <br /> <br />In order to properly evatuace your e~iscing <br />information will be neoessa=y: <br /> <br />~ew&ge system, %he following <br /> <br />If your sewage ~ystem i~ les~ tha~ <br />an approved record of Che system, <br />action on your parC. <br /> <br />five (five) years old, and we have <br />we can prooeed without any further <br /> <br />If your sewage system ds lass than five (5) years old, and we do not <br />have a record of an approved installation of ~he System= <br /> <br />If your sewage s~ste~ is more thaR five (5) years old or has not been <br />pumDer within ~he last fi~e years: <br /> <br />You m~st have the septi~ ca~k pumped, <br />Have the septic tank pumper =omplete the form below. <br />A field visi~ w~ll be ==q~ire~ by the Sanitaraian to verify the <br />location and oo~itio~ of the ~epC£c system. . <br />If you have proof that yo~ s~ptio ~ank has been p~mped within the <br />last five (5) years, sections a & b will not be reguirea. <br /> <br /> For Septic Tank Pumper Use only <br /> <br />COMPANY NAMe: <br /> <br /> ... ..... <br /> <br />AP~aOX~MATS SIZE OF $~PT~C TANK~ ~d~ ........ gallons <br />IS TANK IN GOOD CO~DITION~ <br />~ BAFFLES OR ELBOWS ~N <br /> <br />SEPTIC TANK ~T~RI~: Concre~ ...... Steel_ ..... ~. Other <br /> <br />D~ OF <br /> LOCATION OF TANK: <br /> <br />N <br /> <br /> <br />