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] . 5EWAGE, <br /> Distance to Public Sewers lm—�.-- Connection necessary: Yes No <br /> Does existing septic system comply with Ord . #545 : Yes No— <br /> Unknown If no, explain: r <br /> Descr e epti installation to be installed: <br /> 2 . WATER_SUPPLY <br /> Is water pplied by private well : Yes No �Zs well proper: <br /> Yes NOT 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 <br /> 4�124Ae- f2�j <br /> /e4c <br /> 3. GARBAG & RE MU <br /> . Licensed scavenger p ck-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. F `" Y AL <br /> State possible vector potential & necessary control.: .�ye�ooe` <br /> 5 . Tt TLET/BATH FACILITES } <br /> No. & location existing:._._,_._ Additional <br /> facilities needed <br /> 6 . PRF,YUS_ OPERATION HISTORY. <br /> 7 . GENERAL 26NI' <br /> State any problems not previously noted: ��� <br /> "4 a <br /> 8 . POPULATION_DENSITY <br /> Appx. No. People per sq. mi . <br /> 3 <br /> 'Y <br />