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~UTHO~IZAT£ON NOTICE <br />{~upple~en~al Form) <br /> <br />~ orWer.~o properly evaluate your existing sewage system, the following <br />~n~ormation will be necessary: <br /> <br />rf g~ur sewage system is Ie~$ ~han five (5) gears old, and we <br />hav~ an approved r~cor~ of the $~a=em, we can proceed without <br />any further action on you= ~rt. <br /> <br />If yOUr sewage system is less than five (~) years old, and we <br />do no~ have a r~cord of an approved installatio~; of the system: <br /> <br />Df your sewage system is mo.Fe than five (5) years old or has no~ <br /> <br /> been pumped ~ithin the ias= five years: <br /> <br /> a. You must have ~he septfc tank pumped. <br /> b. Have the Septic tank pumper complete the form below. <br /> c. A field visit will be required by th~ Sanitarian to <br /> verify the location and Condi~io~ of the septic system. <br /> d. If you ha~e proof that gout septic tank has been <br /> ~umped within the las~ five (5) ~ear$, sections a & b <br /> w~l~ not be required. <br /> <br /> -For Se~¢ Tank Pumper Use Only- <br /> <br />APPROXIMATE SI=~ OF SEPTIC TANK:~~llO~$ <br /> <br />NO <br /> <br />MO <br /> <br />zs T~ z~ coco CO~OZTZO~ <br /> <br />D~AGRA~ OF HOUSE AND <br />LOCATION OF TA~K: <br /> <br />EXA~P£E: <br /> <br />-- ~treet ..... '" ~ <br /> <br />ew 2/86 <br />~b <br /> <br /> <br />