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AUTHORIZATION NOT~CE <br />(Supplemental Form) <br /> <br />In order to properly evaluate your existing sewage system, the following <br />information will be necessary: <br /> <br />If your sewage system is less than five (five) years old, and we have <br /> <br />If your sewage system is less than five (~) 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 more tha~ five (5) years old or has not been <br />pumper within the last five years: <br /> <br />Have the Septic tank pumper complete the form below. <br />A fie14 visit will be reef/ired by the Sanitaraian to verify the <br />location and condition of the septic system. <br />If you have proo~ tha~ your septio ta~k has been ~um~ed within the <br />last five (5) years, sec~ions a & b will not be required. <br /> <br />For Septic Ta~k Pumper USe Only <br /> <br />ADDRESS WHER~ TA~K PU~PED~ _. / ~ f~ ~ <br /> <br />APPROXI~TZ SI~E OF SEPTIC T~K:__. ~ ....... ~allon~ <br />IS TANK IN GOOD CONDITION9 / .... YES; <br />~E B~FLES OR ELBOWS IN P~E? <br /> <br />SE~TI~ TANK ~T~I~= Concrete _~ ~ ~' Steel Other <br /> <br />NO <br /> <br />LOCATION OF TA~K~ <br /> <br /> ~ Septic Tank <br /> <br />22 "" well <br /> <br />DA T~ ~. , <br /> <br /> <br />