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1 . SEWAGE <br /> Distance to Public Sewers N / Connection necessary: YesNo <br /> Does existing septic system comply with Ord . #549 : Yes, _T No <br /> Unknown If no, explain: <br /> n <br /> Describe septic installation to be installed: <br /> L 61s <br /> 2 . WATER SUPPLY <br /> Is watjwr supplied by private well : Yes Is well proper: <br /> Yes No State deficiency : <br /> Does �(isting or porposed use make this well pu�c Water: Yes- <br /> No- <br /> esNo Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> c d u S-2 -e 1C r S�Jµ-c CVKt 1_177 t <br /> 3 . GARBAGE 8r1SF <br /> Licensed avenger pick-up: Yes No Servi a Area No. <br /> Other propos d disposal method: <br /> Potential pro em: <br /> 4 . FAL S Qt �i MTO P)'fZLJTIAL <br /> State possible vEc r potFntiFtl & nEces ary control : <br /> 5 . TOILET/BATH FAC_ILTTES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> 6 . PREVIOnS OPERATION HISTO ; <br /> 7 . GENERAL SAP <br /> State any problem nr.;t previou ly noted- <br /> 8 . <br /> oted:8 . MaILATION DENSTTY <br /> APpx. No . People per rq . mi . <br />