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AUTO0 RI ZAT %ON NOTICE <br />(Supplemental <br /> <br />In order to properly evaluate your exfs~ing sewage system, the following <br />~nfo%-m~ion will be B~cessa~y: <br /> <br />Zf your sewage system is less than five (5) years old, and we <br />have a record of the sys~e~, we can proceed without any further <br />ac~io~ on yOUr par~ <br /> <br />~f your sewage system is mor~ than five (5) years old or we <br />do no,t have ~ record O~ the System: <br /> <br /> I~ will be necessary to have the septic ~ank pumped, <br /> Have the septic tank pumper complete the for~ below~ <br /> A field visit w~ll ~e requfred 5y the Sanitarian to <br /> verify the loca~£on an~ condition of the septic system, <br />d. If you have proof that your septic tank has been <br /> pumped within ~he las~ five(5) years, s~ctio~s a & b <br /> above will not be reguired. <br /> <br /> For Septic Tank Pumper Use 0nly <br /> <br />AODRE$$ WHFLRE TAN~< PU~ED: <br /> <br />A~PROXIMATE SIZE OF SEPTIC TANK: <br /> <br />IS TANK IN ~OOD CONDITION? <br /> <br />ARE BAi~FLES OR ELBOWS IN PLACE? <br /> <br /> OF HOUSE A~D <br />DIAGRAM <br /> LOCATION OF T~: <br /> <br />SIGNATURE OF Pb~MPER: <br /> <br /> <br />