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AUTHORIZATION NOTICE <br />($up~lementaI Form) <br /> <br />In order to pro~erl~ evaluate your existing s~wago sgs:em, She following <br />information will b~ necessaFu~ <br /> <br />rf gout sewage sgs=em is ~ss than five (5) gears old, ~nd we <br />have ~n approved record of ~he $~stem, we can p~eed w..~hou~ <br />ang further action on your part. <br /> <br /> If ~oum s~wage sgstem is iu~ ~h~n five ($) goats old, and wc <br /> do no--have a reCOrd of an aSpl~gv~d installation of th~ s~stem: <br /> <br /> ~gO~r Sewa~ ~g~tem i$ ~r~=han fiv~ (~) ge~r~ old or ha~ not <br /> <br /> You mus= have the septic ta~ pum~d. <br /> <br />c. A field visit will bu required by th~ Sanit~gian ~ <br /> <br />d. If ~ou have pr~f that ~our s~pt~C ~k h~s been <br /> pum~d within the l~t five (5) geaz"s, sections a & b <br /> will not be r~uire~. <br /> <br />COMPANy NAME: <br /> <br />YES; NO <br />Y~$; NO <br />YES; XX NO <br /> <br />APPROXIMATE SIZE OF SEPTIC TANK~ <br /> <br />TS TANE IN GOOD CONDitION? <br /> <br />ARE BAFFLES OR ELBOWS IN <br /> <br />IS DR~INFtELD BACEIN~ UP INTO TANK? <br /> <br />DIACRA~; OF HOUSE AND <br />LOCATrON OF TANK: <br /> <br />~ Sepcic Tank <br /> Street <br /> <br />2186 <br /> <br />,qZGNA~URE OF ~U~ER: <br /> <br /> <br />