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AUTHORIZATION NOTICE <br />[Supplemental F6rm) <br /> <br />In omde~ to properly ~vAluate Hour existing Sewage s~stem, th~ follo~in~ <br />information will be necessary~ <br /> <br />.If your sewag~ system is less thA~ five (5) years 01~ ~d we <br />have an approved re=e~d of the sw$tem, w~ can proce6d WiT J lout <br />aD~ further action on ~our part. <br /> <br />If 9ou~ sewage system iA les....~ than five ($) years o1~ and we <br />do not hAV~ A record of an approved i~$~Alletion of the <br /> <br />If ~our sewag~ sgstem is ~or____~ tha~ five (5) gears oi~ ~ hAS n~ <br />been pumped within the la$~ five years: <br /> <br />a. You mUSt have the $~Btic ta~ pu~ped. <br /> Have the Sep:iC tank ~umper ~om~lete the form <br />c. R f~eld visit will be r~quir~d bg th~ Sanitari~ ~ <br /> verl~w the location and ~ndit~on of the septic <br />d. If Wou have proof ~hat ~our septic t~k has be~ <br /> ~umpeg wi:bin the last five {5) gears, sections a ~ ~ <br /> will no~ be required~ <br /> <br /> -~Or Septic ~a~ Use <br /> <br />PROPERTY OWNER: <br /> <br />ADDRESS WW~R~ TANK <br /> <br />APPROXIMAT~ S~ZE OF SEBTZC TANK: <br /> <br />IS TANK IN GOOD CONDiTiON? <br /> <br />ARE BAFFLES OR ~LBOWS ~N PLACE~ <br /> <br />IS DRAZNFIELD BACKING UP INTO TA~K? <br /> <br />If yes, exDlAin~ <br /> <br />DIAGRA;! OF BOUSEAND <br />LOCATZON OF TANK; <br /> <br />EXAMPLE: <br /> <br />sepric Tank <br /> <br />Rev. 3/86 <br /> <br /> <br />