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AUTHORIZATION NOTICE <br />(Supplemental Form) <br /> <br />/~ Order ~o p~perlw mvaluate your ~ximting seWage system, the following <br />information will be ne~essarW: <br /> <br />have an approved re,rd of ~he system, we can proceed without <br />ang further action on <br /> <br /> 2. If gout sewage $~;$tem is ,les..s than five (5) <br /> do not have a record of an aSp=eyed <br /> or; <br /> ~ Four sewa~ sustem is ~r~ th~ fiv~ (5) y~ar$ o1~ or has ~o~ <br /> beem p~d within the l~t five <br /> <br /> FO~ mUS~ have the septic tank pum~. <br /> b. Ha~ The septic t~k p~r ~m~lete the fo~ below. <br /> A field visit will be required <br /> <br /> d. If ~0~ ~ ~f that Wo~ septic t~ has <br /> ~u~d withia the last five (5) Wears, sections a & b <br /> will not be required. <br /> <br /> -For Septic Ta~ P~r USe ~1W- <br /> <br />PROPERTY ~ER: RUSSel and Svl~a Bee~ ........ <br /> <br />ADDRESS WHER~ TANK PUMPED: <br /> <br />10408 Cham,9oegRd. N.E. ~,, <br /> <br />ARPROXIMATE SIZE OF SEPTIC ~ANK: <br />IS TANE IN GOOD CONDITION? ~ YES; NO <br />ARE BAFFLES OR ~L~OWS JN PLACE? ~ YES; NO <br />IS DR~INFI~D BACKING UP INTO TANK? ~YES; ~NO <br />If Fes, explain; <br /> <br />DIAGRAM OF NOUS~ ~VD <br />LOCATION OF TANK: <br /> <br /> Se£tic Tank <br /> <br />22~ <br /> <br /> <br />