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AUTHORIZATION NOTICE <br /> (supplemental Form) <br /> <br />-In. orde~ to properly evaluate your existing sewage <br />information will be necessary= <br /> <br />system, the following <br /> <br />If your sewage system is less than five (five) years old, and we have <br />an approved record of the system, we can 9roceed without any further <br />action on your part. <br /> <br />If your sewage system is less than five (5) years old, and we do not <br />have a record of an approved installation of the system: <br /> or; <br />If your sewage system is mote than five (5) years old or has not been <br /> <br /> pumper within the last five <br /> <br />b. <br /> c. <br /> <br />You must have the septic tank pumped, <br />Have the ~eptic tank pumper complete the form below. <br />A field visit will be required by the sanitaraian to verify the <br />location and condition o~ the septic system. <br />If you have proof that your septic tank has been pumped within the <br />last flys ($} years, sections a & h will not be required. <br /> <br /> For Septic Tank Pumper Use Only <br /> <br />~PROXI~T~ ~IZ~ OF SEPTIC T~K: ~~.~ gallon~ <br />TANK IN ~D CO~ITION9 ~S; NO <br />~ ~F~ OR ELBOWS IN P~CE9 ~ Y~S; NO <br /> <br />iS DRAINFI~LD BACKING UP iNTO TANK? <br /> <br /> If yes, explain;_ <br />SEPTIC TANK MATERIAS: Concrete f <br /> <br />steel~Other <br /> <br />o:r. Ab-qU O HOUSE <br /> LOCATION OF TA~K~ <br /> <br />I22 ~ wXell <br /> <br />w <br /> <br />N <br /> <br />3~e2 Rev 10/87 <br /> <br /> <br />