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1 . SEWAGE <br /> Distance to Public Sewers ti �� Connection necessary : Yes No 's <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic install tion 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 porposed use make this well ptip2ic water: Yes <br /> No Semple of well water tarsen: Yes No Date taken <br /> Results Additional information or comments <br /> Wed <br /> 3 . GARBAGE& REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential probl"sm: <br /> 4 . _QSQUITQ OR V ^.TQ) aC)rjjLT?Au <br /> State possible vett, r potentiztl essary control : <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed _ <br /> 6 . PRFVIona C;PERATI�_ id <br /> 7 . GENERAL SAPjTjgjT(�R <br /> State any problem^ not previously noted :_ <br /> 8 • F- ILATION DENSITY <br /> Appx . No . People per rq . mi . <br />