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:~.n Ord~;~ tO t~ro~,~-ly ~a~llate yO~%~ ~,X~At.~g 5¢~'a~ ~ystt~m, t~ fO~ng <br />in~r~t~on ~ be n~ccs~a~y~ <br /> <br /> ~. I~ yoUc ~c~'a~e system is ~e~ lhan five (tire) y.~:~rs old~ .~nd ~'~ haw <br /> action on your part. <br /> <br /> 2. If yo0r sewage s~stem is less than five (5] y~ars o1~, and we do not <br /> have a record of an approved installation,of the ~ystem~' <br /> or; <br /> <br /> For Septic Tank Pumper Use Only <br /> <br />Nm.:~zL?_~ta__~__on,.,_Mill C~ty & Silv~ ~tic ~CyEQ L~C~:~SS NO:_ 349~6 <br /> <br /> TANK PO~4PED: 255 ~ti~ Ave. <br /> ~it, ~ <br /> <br /> ~IZE OF SE~TIC TANK: 500 ~2allo~$ <br /> <br />i$ TANK IN GOOD C©NI)ITION? <br />ARE ~3AFYLE~ OR EL;~OWS IN PLACe:? <br /> <br />IS D}%AINFI}ZLD BACKING UP INTO TANK? <br /> <br />· __XX. ........ Y {.; s; NO <br />__ ~ ..... %')-,' S ~ ............. NO <br /> <br />...... ~r:s; ...XX_.~NO <br /> <br />If yes, explain; <br />5YJFTIC TANK {4ATERIAS: Concrete Stool ~ Other <br />~ it ~ a ~ lld ~1~ <br /> <br />D~'AC'.~d'f OF i{OUSE A~;D <br /> <br /> <br />