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~AUTHORIZATZON NOTICE' ' <br /> (Supplemental Form} <br /> <br /> order to props~ evaluate your existing sewage sgstem, the following <br />t/;forma~on wil~ be nec~ssar~r ' <br /> <br />have an appr~vod record o~'t~e system, we can proceed wi~hou~ <br />.any further action on ~our~part. <br /> <br />your s~¢age system is less ~han five (~) gears old, and we <br />~ot have a re~ord of an approved installation of the system= <br /> <br />~our sew~g~ system ~s mo~e than five (~) ~sar~ o1~ o~ has not <br /> <br /> been pumped w~thin the laat~five <br /> a. You must have ~hs sept'~o tank pumped. <br /> b. ~{ave the septl~ tank purer ~mplete the form <br /> c. fl field visit will be =squired bg She sanitari~ <br /> <br /> 2f gou ha~e pr~f that ~our septic t~k has <br /> pum~d within the last five [~) gears, sectlone a · b <br /> will not be r~uired. <br /> <br />COMPANY N~E: Stayton Septic Service D~ ~ 6 <br /> <br />~O~SRT~ ~F~: Wayne Brown <br /> 10664 Silver Palls Hwy. F "' <br /> <br /> Aumsville, OR . <br /> <br />1250 ~aJIons concrete <br /> <br /># <br /> XX NO <br /> <br />'ARPRO,¥Z~ATE SIZE OF $~PTIC TANK: <br /> <br /> IS TANK IN GOOD CONDITION? <br /> <br /> A~ ~AFFLES OR E~BOW$ IN P~CB~ <br /> <br /> IS DR,IINFI£~D BACKING UP ~NTO TANK? <br /> <br /> If yes, explain; ..... <br /> <br />/,~f~.GRAM QF ffOUSE AND <br />~/XiATION OF <br /> <br />E,%;1MPLE: <br /> <br /> <br />