Laserfiche WebLink
A~TH~R~ZAT~ON NOTICE <br />(Supplemental Form) <br /> <br />In order to properlg evaluate yOUr existing sewage s~stem, the followin~ <br />info£ma=i~n will be ne~e~sarg: <br /> <br />If gour sewage sgstem is less than five (5) gears old. and we <br />have a~ approved recold of the sgstem, we can proceed w~thout <br />anw further action on gout Bart. <br /> <br /> If gout s~wage sgstem is less than five (5) 9ear~ old, and we <br /> do ~o~thave a FeCord of an approved installation of the <br /> <br /> If ~our sewag~ $~atem is ~ th~ fi~ (5) gears old or ham not <br /> beeo $~d within the last five gears: <br /> <br /> a. You ~ust have the septic tank p~m~d. <br /> b.. Nave the septic tank pum~r complete the form below:' <br /> c. A' field vim~ will ~ required by the S~itarian to' <br /> verif9 the location a~d ~n~iti~ of the septic.system] <br /> d. If gou have ~r~f ~hat gOU~ septic t~k has been <br /> pumped within the last five (5) Ue~s, sections a & b, <br /> will not be r~uired. <br /> <br /> -Fo~ S~p~ic Ta~ ~um~r use ~lg- - <br /> <br /> I <br />ADDRESS <br /> WNE~ TANK <br /> <br />x-~.o~r~ szz~ o~ s~P~rc <br /> <br />I$ TANK IN GOOD CONDITION? <br /> <br />A~ ~AFFLES OR E~OWs IN PLAC~ <br /> <br />IS DRAINFIELD BACKING UP INTO <br /> <br /> If wes, explaie; ..... <br /> <br />wallons <br />~ES; NO <br />~'/YES; NO <br />YES; ~/~ <br /> <br />DIAGRA~ OF HOU$B AND <br />LOCATION OF TANK: <br /> <br />~XAMPA~: <br /> <br /> 6 ' ~ Septic Tank <br />I£2~- .... <br /> <br /> St~oet <br /> <br />Rev. 2/86 <br />.omb <br /> <br />SZGNATUR~ <br /> <br /> <br />