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1 . SEWAGE - <br /> Distance to Public Sewers Connection necessary: Yes Nom <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown ✓✓ If no, explain : <br /> Describe septic installation to be installed : <br /> Z . WATER SUPPLY <br /> Is wat supplied by private well : Yes `� No Is well proper: <br /> Yes No.__ 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 /> 3 . GARBAGE <br /> Licensed avenger pick-up: Yes No Service Ar a No . <br /> Other prop ed disposal method: <br /> Potential pro lens: _ <br /> 4 . =1 Y. L i O OR Z^. EC)F_B 1AL <br /> State possible vi,. for potential & necessary c,ntrol : <br /> 5 . TQILET/BATH FACILITS <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H=ffa <br /> 7 . GENERAL SANIT/ 'ION <br /> State any prolDletnc not previously noted: <br /> 3 . POPULATIQN DENSITY <br /> Appx . No . People per sq . mi . _ <br />