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<br /> <br />,,' <br /> <br />AUTHORIZATION NOTICE <br />(Supplem.nt~l Form) <br /> <br />In ö~ð~r ~o properly evaluate your existinq aewQSc ~y~tem, the fol10win9 <br />information will be necessary: <br /> <br />1. Xf your sewage system 1s 1... than t1ve (five) years old, and we \have <br />an ap9rov.d record of ~ho system, we can proceed without any fur~her <br />action on your part. <br /> <br />2. <br /> <br />If your sewage system i. le.. than five (5) years 014. and We do not <br />hav~ a record of an approved installation of the .ystem' ' <br />o:n <br />If your sewage system is more than flve (5) years old or has not been <br />pumper vltbln the last live years: <br /> <br />d. <br /> <br />You must hav. the s.ptic tank pumped. <br />Have the septic tank pù~r complete the form below. <br />A field viBi~ will be: (.~i..d by the Sanitara!an to verify the <br />location and con4it1on'ot the septic system. <br />tt you have prøof ~h.C:~r septic tank has been puæpeð within ~he <br />l~Bt five (5) year., .actions - . b will not be require4. <br /> <br />a. <br />b. <br />c. <br /> <br />_M~~D~~.-___M._.__.--..._----............_-_._---_.._-----....-..----.....-- <br />For Septic: :r.nk Pumper U.e Only <br />COMPANY NAM,E:4t1t;'" ~....~~ ..>::;.........---,...... DEQ LICENSI!: NOI~J"(}/J' <br />P~OPERTY OWNER, L'1& !U 'p~r:+ <br />ADDRESS wanE 'rANK l'UM.PW: .4¿r:>. Z >..-'- <br />f'Pdrr,;.¡. 6,e <br />APPROXIMATE SIZE OF SBP'I'tc TANK.: 'ì~() ßlðo/ -- .gallons <br /> <br />tS TANK IN GOOD CON!):r:TIO~? <br />ME BAFFLES OR ELBOWS IN PLAct? <br /> <br />¡ß DRAINFIEItÐ BloCKING UP INTO, TAN~? , <br />It yes, exp14in; <br /> <br />t\ yes, <br />]I( YES , <br /> <br />rES, <br /> <br />NO <br /> <br />NO <br /> <br />bt <br /> <br />NO <br /> <br />SEPTIC TANK MATERIAL: Concr.~. <br /> <br />Stael--A( <br /> <br />Other <br /> <br />DrAClW{ OF HOWE .um <br />LOCATION or v.m:: <br /> <br />N <br /> <br />" <br /> <br />EXAHPlJ¡: <br /> <br />ø $ep1;J.c '¡'<Ink <br /> <br />w <br /> <br />1;:1 <br /> <br />6' <br />2']'" <br /> <br />x <br />well <br /> <br /> <br />o~ <br /> <br />.,' <br /> <br />'S <br /> <br />3/82 "'..V 10/87 <br /> <br />,. , <br />Sir;1(ld!URE 01' PUNP:S((,I <br />.DA'U:,-. <br /> <br />