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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No, <br /> Does exist�,ng septic system comply with Ord . #549 : Yes No_ <br /> Unknown t� If no , explain: <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 /> rn ire ✓ l I e ( i s �o <br /> Does existing or porposed use make this well pubic water: Yes <br /> No ,` Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE�� REFUSE <br /> Licensed &qavenger pick-up: Yes No__ Service Area No . <br /> Other propo d disposal method : <br /> Potential pro em: <br /> 4 . FLY c ICTOR POEXTI L <br /> State possible ve` r potential & rilelplelss <br /> ary control : <br /> 5 . TQI , .LET/BATH FACILI7la <br /> No . & location, exiting : Additional <br /> facilities needed---- <br /> 6 . <br /> eeded _6 . PREVIOUS OPERATIOILHIBMEY <br /> 7 . GENERAL SANITATIOB. <br /> State any problems not previously rioted: _ <br /> 3 . P r 1 ,ASN DENSITY <br /> Appx. No . People per sq. mi . - <br />