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1 . SEWAGE <br /> Distance to Public Sewers r\; T// Connection necessary : Yes No..' <br /> Does existing septic system comply with Ord . 0549 : Yes No.Y_ <br /> Unknown If no, explain: <br /> do <br /> J <br /> Describe septic installation to 'be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No-, Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porpcsed 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 /> /rS e->1 .14 rc e/ - Va-Cad ' la 0'a- <br /> 3 . �FLISE <br /> Licensed caveneer pick-up: Yes No Servi rea No . <br /> Other prop sed disposal method: <br /> Potential p blem: <br /> 4 . FILL,_ MOSQUITO OR VQ.T() �'r1LN11AL . <br /> State possible v€:ctor potential seary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location, existing: Additional <br /> facilities needed <br /> 6 . PREVIO02 OPERATION HISTORY <br /> 7 . GENERAL SAIIIT,aTION <br /> State any problem: not previously noted: <br /> 8 . ROPULATION DENSITY <br /> Appx. No . People per rq . mi . <br />