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.arlon County <br /> OREGON <br /> <br />pAC_~ 82 <br /> <br />carefully. <br /> <br />requirements apply to the evaluation of an existing <br />Please select tbs apprbpria~e section and follow the direceione <br /> <br />Cert£f~cate of Satisfactory Completion has been issued for the <br />system, the septic tank does not require pumping at this t~me. A <br /> <br />If your sewage system le ~ore than five (S) years old end the <br />septic tank has not' be~n*pumped ~lthin the last five (5) years, <br />follow the d£rectiens' below. If you have proof that the septic <br />tank has been pumped within the last five ($) years, sections (a) <br />and (b) wll~ not.be required.' <br />a. The septic tank ~us~ be pumped by a D,E.G. licensed septic <br /> tank pumper. <br />b. The oe~tio te~ p~p~r mUSt complete the £ozm belo~. <br />c. A ~le~d inspection will be required'by Our On-Bite eta~ to <br /> <br />*for empt£c ~;am~per use only* <br />'(please print) <br /> <br />PROPERTY O~N~R: ,,, <br /> <br />P~OPERTY ~DDI~E8$: <br /> <br />DZA~ OF HOO3E AND SEPTZC ~NR:, (~hov detail uith meaearemente) <br /> <br />~.$-slg, (S03) .588-$'/47 <br /> 10-92 <br /> <br />SenaK~' Build.s, ~nd Floor <br />220 Hieh Si*, NE- Salem, OR 97](JI-)670 <br /> <br />DATE OF PUMPING <br /> <br /> <br />