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AUTHORIZATION NOTICE <br />(Supplemental Form) <br /> <br />In order to properRy evaluate your existing sewage systems 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 is'more than five (5) years old or we . <br />do no_t. have a record of the---~ystem: <br /> <br /> a. It will be necessary to have the Septic tank pumped, b~ <br /> b. Nave the septic tank pumper complete the form Below. <br /> <br /> verify the location and condition of the septic system. <br /> d. If you have proof that your septic tank haa been <br /> pumped within ~he las~ five(5) years, sections a & b <br /> above will not be required. <br /> <br /> - For Septic Tank Pumper Use Only <br /> <br />ADDRESS WHERE TANK PUMPED: __~.~ ~ <br /> <br />3/82 <br /> <br />APPROXIMATE SIZE OF SEPTIC TAN~: <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 />EXAMPLE: <br /> <br />.... beret_. <br /> <br />~5'"'--0 ¢ gallons <br />~ NO <br /> <br />SIGNATURE OF PUMPER <br /> <br /> DATE: '~ ~ _~ '- ¢'¢'..__ <br /> <br /> <br />