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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 /> 2 . WATER SUPPLY <br /> Is water supplied. by private well : Yes _ No_ Is well proper: <br /> Yes_ No_ State deficiency: <br /> Does existing or porpoeed use make this well public water: 'les <br /> No Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARRAQ7 & RRTUSR <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY MQSAUTTQ OR VTC^TQR PO'r*'NTTAr, <br /> State possible vector potential necessary control: <br /> 5 . TOTT-FT/13ATTT TACTTTTFa <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PRryTQns rpT.RATToV RT,TnyT <br /> 7 . Gn^.NF.AAT .Sa 7- ^A + Tt�N <br /> State any problems not Previously noted : <br /> App; . No . ?t--ple 7gr 3s . M-4 . <br />