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Al <br /> ' s <br /> 1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes Nod... <br /> Does existing septic system comply with Ord . #549 : Yes-,X- No_,..., <br /> Unknown If no, explain: <br /> c _ <br /> - - - � l4 -Sin" �„ 4l..,L ._._,__... ,....--- <br /> Describe septic installation to be installed: <br /> 2 . MATER_ SUPPLY <br /> Is water supplied by private well : Yes well proper- <br /> Yes No State deficiency: <br /> Does existing or parposed 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 . <br /> Licensed stave ger pick-up: Yes No Servi Area No. <br /> Other proposedsposal method: <br /> Potential problem <br /> 4 . aff,_ MOSQUITO OR V �`-. PS�' iI3T <br /> State passible vecto atenti ei & rtes; scary control: <br /> 5 . TO FACILITES <br /> No. & location existing : _ Additional <br /> facilities needed <br /> 6 . EMIQU SPE TION HIST <br /> 7 . GENERAL SANITATI , <br /> State any prat ms not previously noted :— <br /> 8 . pCLP L TIQU DENSITY <br /> Appx, No. People per sq. mi . <br />