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1 . SEWAGE <br /> Distance to Public Sewers ti 'r=� 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 /> /l�o� <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes ilo_ Is well proper: <br /> Yee i No_ State deficiency :_ <br /> Does existing or porposed use make this well public water : Yee <br /> No . Sample of well water taken: Yes_ No Date taken <br /> Results Additional information or comments <br /> 3 . 1SE <br /> License scavenger pick-up: Yes— No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential oblc-m : <br /> 4 . FLY. Scr ^TO )MHUAL <br /> State possible or potential & nece sary control : <br /> 5 . TOILET/BATH FACILITES / <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PRFVTOf7S OPFF=0yl-j=, •Y <br /> 7 . GENERAL SAtUTA1'?ON <br /> State any problems of previously noted: _ <br /> 3 . POPULATION DENSITy <br /> APpx . No . Peop e per sq. r.,i . <br />