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SEWAGE <br /> Distance to Public Sewers Connection necessary: yesNo_ <br /> Dees exialing septic system comply with Ord . #549 : Yes <br /> Unknown If no, explain: No_, <br /> Describe septic installation to be installed: <br /> 2. WATER SrFpLy <br /> Is Water supplied by private well : Yes NO Is well proper: <br /> Yes No State deficiency: <br /> Does existing or pooposed use make this well public Water: Yes <br /> No Sample Of well water taken: Yes No Date taken <br /> Results.__ Additional information or comments <br /> 3 . GAR_ AAGF & RRFOSF <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 • Fr Y. M gnnTTn OR VI?^TnR P(-j'rCNTTAr, <br /> State possible vector potentiell R.i necessary control- <br /> 5 . <br /> ontrol:5 • TnT ,F /BATH M Ac'T7,TTF^ <br /> No. & location existing: Additional <br /> Facilities needed <br /> 6 . PRRVIOU nPERATION uT^Tnry <br /> 7 • G7NERA T, SA"ITIAT7 <br /> State any problems not prel;OU 17 noted : <br /> 3 . <br /> Apex . No . ��.` :� e per <br /> 3 q . L1. <br />