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AUTHORZ~ATXON NOTICE <br />(Supplemental Form) <br /> <br />In order to~X~9~lF evaluate Four existing sewage <br />information will be ~ecessarg~ <br /> <br />Tf 9our sewage sgste~ is leqe ~ha~ five (5) <br />have an approved record of the sFs~em, we <br />an~ further aCtio~ On <br /> <br />If yOU~ Sew~ SFSt~ iS .le~$.than five (5) <br />do not have a record of ~ ap$xoved installa <br /> <br />~ ~our s~a~ s~stem is ~ th~ fi~ (5) <br />been p~d wi~in ~he 1~ fl~ ~o~msr <br /> <br />b. <br /> <br /> You mus= have ~J~e septic <br /> Have the septic tank p~mper <br /> <br /> ve=ifw the locati~ ~ condition ~f ~he sestic s~stem. <br /> d. If gou ~ve ~f =ha~ Four se~ti~ t~k h~ b~n <br /> p~W wi:hin the l~t five (B) Fears, sections a & b <br /> will no= be required. <br /> <br />c~ N~: Stayton Sep~!q Se~ice eZQ ~ ~, ~4916 <br /> <br />~DRESS WHE~ TANK PUMPED: 7727 Sherman Rd. · ; · <br /> <br />~PR~IMA~ SIZE OF SE~IC T~K: 1250 gallons concrete <br /> <br />IS TANK IN GOOD CONDiTION? <br /> <br />XX YES: NO <br /> <br />ARE BAFFLES OR B~OWS IN PLACE? <br /> <br />IS DRAZNFIELD BACKING U~ INTO T~J~K? <br /> <br />~.__YE$; NO <br />YES: XX NO <br /> <br />If Wea, explain; <br /> <br />Rev. <br /> <br />DIAGRAM OF HOUSE ~ND <br />LOCATION OF TANK: <br /> <br />EXAMPLE: <br /> <br />  <br />Septic Tank <br />22 ~- <br /> <br />2/86 <br /> <br /> <br />