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a <br /> 1 . SEWAGE <br /> 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 installa#ion to 'be installed: <br /> �,oyLP <br /> 2 . MATER SUPPLY <br /> Is water supplied by private well : Yes No 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 Na Date taken <br /> Results Additional information or comments <br /> 3 . GA$B .F[1SE <br /> License cavenger pick-up: Yes No Service �eano. <br /> Other prop ed disposal method: <br /> Potential pro lens: <br /> 4 . FGA'L sc t r ^TO _EC f <br /> State possible ve or potentiftl & neceary control: <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> 6 . PRPRVTOTIS OPERATION HISTnRY <br /> 7 . QENERAL SANI' • TION <br /> State any problems not previously noted:- <br /> 8 . <br /> oted:_8 , pn P 1 iATION Dr i <br /> Appx. No . People per Bq. mi . <br />