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OHM <br /> Distance toTPublic Sewers Connection necessary: <br /> Does existing septic system comply with Ord. 0549 : Yes` <br /> Unkno4n� If no, explain: Yes No_ <br /> Describe septic inatallation to 'be installed: <br /> 2. F r7p <br /> Is Writer supplied. by private well: Yes Floes rs wellYes No4C tate deficiency: Proper: <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 . G a R R AQ T ,. <br /> Licensed scavenger pick-tip: Yeses. Na Service Area No. <br /> Other proposed dispoeal method <br /> Potential problem: <br /> 4. n nTT <br /> State possible victor Potential & necessary control.: <br /> No. & location exit ting: . <br /> facilities needed- <br /> 7. <br /> eeded Additions) <br /> S• art^ r' '" n a ;Tn <br /> 7. GEUM T, - tr-^►a T�, <br /> State any problems not Prev{cusly noted : <br /> '�P:. No . ?r:ple per 0q . M1 . <br />