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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 15 tess than five (5) years old, and we <br />have a record of the system, we cab proceed without any further <br />actio~ on y~ur part. <br /> <br />2. If your sewage system is,,mere then five (,$5 years old or we <br /> do not have a record of the system: <br /> <br />It wilt be mecessary to have the septic tank pumped. <br />Have the septic tank pumper complete the form Below. <br />A field visit ~rili be required by the Sanitarian to <br />verify the location and condition of the septic system. <br />If you ha~e proof that your septic t~nk has bee~ <br />pumped within rh$ last five(5) yeats, secti~s-~r&_b <br /> <br />- F~r Septic Tank Pumper Use Only <br /> <br />COMPANY NAME:~ <br />P RDPERTY OWNER: <br /> <br /> ~AR.I~N ~fi?~Tv <br /> BLIII. D NG iNSPECTION <br />DEQ L:IC]BNSE NO:~I <br /> <br />3182 <br /> car <br /> <br />A/PFROX~TE SiZE OF SEPTIC TANK: <br /> <br />IS TANK I~ GC~OD CONDiTIOn? <br /> <br />~ BAFFLgS OR ELBOWS IN PLACE? <br /> <br />DIAGRAM OF HOUSE AND <br /> LOCATION OF TA~K: <br /> <br /> EXAMPLE: <br /> <br />-~---~- .............. ~-! ..... ~.1 i ,, <br />-.: <br /> <br />NO <br /> <br />SIGNATURE OF PUMPER~~DATE: <br /> <br /> <br />