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AUI~HO RI ZATION NOTICE <br />(Supplemental Form) <br /> <br />In 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) years old, and we <br />have a record of the system, we can proceed without any further <br />action on your part. <br /> <br />If your sewage system i$ more than five (5) years old or we <br />do not 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 will he required 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 />3/82 <br /> car <br /> <br /> - For Septic Tank Pumper Use Only - <br />ADbRESS WHERE TAiqK PUMPED: <br /> <br />DEQ LICENSE NO: '> z4 ~'71g~ ~ <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK: <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />DIAGRAM OF HOUSE AND <br /> LOCATION OF TANK: <br /> <br />gallons <br /> <br /> <br />