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SEJJAGE <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord. #549 : Yes No— <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER atIppr'y <br /> Is water supplied- by Private well: Yes No Is well proper: <br /> YesNo State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments -in�rr-7 <br /> yn <br /> 3 . F & REF12SE 5 11� e.JawC-P 5 7 k-0 <br /> mea No. <br /> Other 1 meth_o(i <br /> Potential rob1-43-m <br /> 1 <br /> 4. FL MOSOQLTO OR V j n ?�j � LaaS5r�lr <br /> State passible vett ratentifRl n cessar control: <br /> v <br /> 5 . TC}ILF.T/BATH CACILITES <br /> No. 1140 f2 a2222 Addittcnal <br /> n <br /> facilities needed 7,-A_ I.5 <br /> dr <br /> 42 2L'o <br /> 7 . GENERAL ,SQA ,TITA'FIc3N <br /> MTOR <br /> State any problems not previou-sly noted: v`/ <br /> 8 . POPUI,ATTON DENSITY .r-- <br /> APpx. No. People per eq. mi. <br /> /� Z 12 <br />