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1 . SEWAGF <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 /> Y70 <br /> 2 . WATER SUFPLY � <br /> Is water supplie b. private. we'll : 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 & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> n ial problem: -��' <br /> J7 / o"Ma POIM <br /> 4. ='I- MQSQUITQ QR TIAL <br /> Stag- 5-" e ve tar potFritiftl do necessary control : <br /> t � r <br /> 5 . TOTLET/BATH FACILITES ~i r1,�,,r e __.t" �-,► }j i�.�' <br /> No . & location existing:,",-----, Additional <br /> facilities needed _ <br /> 6 . PRF`VIOr1S OPERATION HISTO ; <br /> i <br /> 7 . CEN ERA . SANI'r '1„J� 'S( <br /> State any problems not Previously noted: <br /> 8 . POPULATION DENSTly <br /> Appx. No . People per req . mi . <br /> S 0 - 12 N Or <br /> _. <br /> cl <br />