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AUTHORIZATION 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 />2. If your sewage system is 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. Maya the septic tank pumper complete the form below. <br /> c. A field visit will be required by the Sanitarian to <br /> verify the location and condition of the septic system. <br /> d. If you have proof that your septic ~ank has been <br /> pumpedabove ~-illWithinnotthebe required.last five(5) years, sect~7~. &~b I~ ~ 'i~ <br /> <br /> ~RiO~ GOUNTY <br /> ................ ZOO' 'Septic Tank Pumper Use Only - BUILDING INSPECTION <br /> <br />CO~A~ ~E: ~ DEQ LICENSE <br />P~PER~ OWNER: ~ <br />ADDRESS ~E T~ P~ED: <br /> <br />3/82 <br /> car <br /> <br />A~PROXIMATE SIZE OF SEPTIC TANK: <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />ARE BAFFLES OR ELBOWS IN PLACE? <br /> <br />DIAGRAM OF MOUSE AND <br /> LOCATION OF TANK: <br /> <br />] OOC~ <br /> <br />gallons <br /> <br />SIGNATURE OF PIFMPER~DATE: <br /> <br /> <br />