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r <br /> • t <br /> Al��� <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549 : Yss <br /> Unknown. If no; explain: ......_. No_ <br /> Describe septic installation to -be installed: <br /> 2. WTRR sUppIl ► � � ; ' <br /> Is Nater supplied. by private well : Yes Na Is well proper: <br /> Yes No State deficiency: <br /> Does existing or-rporposed use make this Heil public crater: Yes. <br /> No Sample of well water taken: Yes No Date taken <br /> Results ;` Additional information or comments <br /> 3 . <br /> Licensed scavengerick-up: Yes No Service Area No. <br /> Other proposed di poral method: <br /> Potential problem: <br /> 4. ,rinR EQ. , <br /> State <br /> Possible vector pot rel & necessary control: <br /> 5. TOTLETOATH <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. 2REVIOUS OEERATTON RTRTnRV- <br /> '000" <br /> r <br /> k <br /> 7• <br /> State any problems not Previously noted: �- <br /> i <br /> $ . 0 3 v <br /> Appx. No. People per .eq. mi . <br /> � �-5 2 <br /> _ f <br />