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AUTHORIZATION NOTICE <br />(supRlementaI Form) <br /> <br />In order tO properl~ evaluate ~ou= existing sewage system, the following <br />in~rmtion will be necess~g: <br /> <br />Tf your sewage sgst~ is le$__s tha~ fi~ (5) gears old, and we <br />have an approved re~d of the system, w~ ~an proceed witho~ <br />any further action on Wour part. <br /> <br /> ~. If g~ur sewag~ system ia le$~ than fiv~ (5) gears old, a~d we <br /> do n~ have a re,rd of ~ ap~o~d installation of the <br /> ~r; <br /> ~ ~our s~a~ s~stem is ~re ~h~n fi~ (~) ~rm o1~ o~ has not <br /> b~en pumped wi=him th~ last fi~ gears: <br /> <br /> a. You ~s~ ha~ the sep~i~ t~ pu~d. <br /> <br /> A field visit Will ~ required by the Sanitari~ to <br /> verify the looat~on ~d ~nd~t~on uf th~ stoic <br /> If ~ou ha~ ~f that ~Our ~eptic t~k has been <br /> pureed with~a =he l~t fl~ (5) wears, ~e~tions a & ~ <br /> will not b~ ~uir~. <br /> <br /> -F~r Septic Ta~ ~m~m US~ <br /> <br />IS ~ IN G~D C~TION? ~; ~o <br />~ SAEF~S OR ~ Im P~C~ ~YES; <br />IS m~mFI~Lm BACKING ~ ~0 ~ ~YES; ~0 <br /> <br />Rev- 2/86 <br /> <br />DATE; <br /> <br /> <br />