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1 ' S 'WA " <br /> Distance to Public Sewers �� Connection necessary: Yes_ Nom <br /> _.� <br /> Does existing septic system comply with Ord. 0549 : Yes_ Nom <br /> Unknown If no, explain: <br /> /VOo7�rc a ani <br /> Describe septic installation to be installed: <br /> o <br /> Z . WATERER SUPPLY <br /> Is water supplied by private well : Yes _ NO X 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 rvice Area No . <br /> Other pro ed disposal method: <br /> Potential p oblc-m: <br /> 4 . EI,Y 6 CTO �fTN <br /> State possibleector potential & necessary control : <br /> 5 . TQT FT/BATH FACT TT S <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVTOUS OPERATION HjSTORX <br /> 7 . GENERAL SAtIrATTON <br /> State any problems not previously noted: <br /> 9 . POPULATTON DENSTTY <br /> Appx. No . People per sq. mi . <br />