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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes NoY <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 /> t�9dPE.� Yes No-,I(- State deficiency: C' --�d. ✓o .s✓/• .�r��/f'E9.G�tc/,�o�-✓�►,GE✓FG. <br /> /��PO✓�✓.I'f�.G //;� � �//l L 70 //d��1✓��/1����/S'�/t <br /> �— 6�ad�o .GE✓E� S� 'GE9i1 �/EEoi ���t 4/f.l !�✓rte <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 .P.��rF <br /> i!'oT,�c�rf��.,�/�i������.�o�f�ed�.�l��,e �'�-`E�t' G/c�f�✓9.�'aGi-P�o�� <br /> ®le- <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No� Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . SLY, LjQ3 ►UITO OR '=OR POTENTIAL <br /> 5 . TOILETiBATH FACILITES <br /> No. & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION / <br /> State any problems not previously noted: <br /> 8 . POPULATION DENSITY <br /> Appx. No . People per sq . mi . 1��lidE /��/�iP/l�✓�/Tyl <br />