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A0~/ORIZATION NOTICE/~XIST~NG SYSTEM EVALUATIO~ <br /> <br /> following informa=ioa will be necessary: <br /> <br /> It ~ill be neccszary ~o ~ave thc septic tank <br /> pumped <br /> <br /> the form below <br /> A field visit will b~ required Dy tho Sanitarian <br /> to verify the location and Condition of the scptic <br /> system <br /> <br /> and b above ~ill not be required. Provide <br /> this office. <br /> <br />COM~AaNy N~:,, · ...... D~Q LIC~NS~ NO: ~ <br /> <br />PROPERTY <br /> <br />ADDP~ES$ WHERE TANK <br /> <br /> APPROXIMATE $IZ~ OF ~PTIC TANK: <br /> <br /> AR~ ~FFL~$ OR ZL~WS IN P~CS? <br /> SEPTIC TA~b~T~RIAL: Concrete $=eel O~her~ <br /> <br />~TEON OF T~: <br /> <br />W <br /> <br />SIGNATURE OF <br /> <br /> DAT~ OF ~UMPING; <br /> <br /> 97 <br /> <br /> <br />