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AUT~O RIZATION NOTICE <br />(Supple~nental Form) <br /> <br />In order 60 properly evaluate your existln~ sewage system, the rolls,ring <br />information will be necessary: <br /> <br />have a record of the syste~, we can proceed without any further <br />action mn your parr. <br /> <br />your sewage system is morse than five (5) years old .or we. <br /> <br /> b. Have the septic tank pumper complete the form b~%ow. <br /> C. A field visit will be required by the Sanitarian to <br /> <br /> d. If yo%% have proof that your ~eptic tank has been <br /> pumped w~hin ~he Iae~ five(5) years, sec=lons a & b <br /> above w~11 not be required. <br /> <br />3/82 <br /> car <br /> <br />- For Sep~$e Tank Pumper Use Only - <br /> <br />APPROXI}~TE SIZE O~ SEPTIC TAN~: <br /> <br />IS TANK IN GOOD CONDITION? <br /> <br />A~E BAFFLES OR ~j~OwS IN ~LACE? <br /> <br />DIAGRAM OF HOUSE AND <br /> LOCATION OF TANK: <br /> <br />7j~) gallons <br /> <br /> <br />