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1 . SE�WA F <br /> Distance to Public Sewers A Connection necessary: Yes_ No_X <br /> Does existing septic system comply with Ord. #549 : Yes_ No_ <br /> Unknown If no, explain: <br /> A)e elf s f►%� syrSoEP„v, <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes _ No�Is well proper: <br /> Yes_ No_ State deficiency: <br /> Does existing or porpoeed use make this well pub is water: Yes <br /> No Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> tG wnwell 0 On+- /2 k-ayk—j <br /> 3 . GARBAGE & REFUSE / <br /> Licensed scavenger pick-up: Yes_ No= Service Area-Vo . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY MOS©UTTO OR VEMR PO'Mc,TIAL <br /> State possible ctor potential & necesy control: <br /> 5. TOILET/BATH FACILiI_TF. <br /> No. & location existin Additional <br /> facilities needed <br /> 6 . PRF.VIOt1S CPRRATION HIST <br /> 7 . GENERAL SAM <br /> State any pro lems not previouel noted: <br /> 8 . n tyITY <br /> Appx. N . People per eq . mi . <br />