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1 . 5.EWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord . #549 : Yes No— <br /> Unknown If no, explain : <br /> Describe septic installation to be installed : <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> f Yes <br /> No St/ate deficiency : <br /> U�fJQI SP4� Q'd74E�LT, t LVA !� t� q c/fLT.va' <br /> /. '11" P � Q"'S'G ' <br /> Does existing or porposed use make this wel pub is water: Yes <br /> No Sample of well water taken: No Date taken <br /> ( Resdlts — Additional information or comments <br /> (Q,I 31 a .r I -e - f L 5 dl' wye Q O 02 L..'er <br /> 3 . GARBAGE & REFUS� <br /> Licensed scavenger pick_up: Yes No Service Area No. <br /> Other proposed disposal method : <br /> Potential Problem: <br /> 4 . F.LYL MOS4`�tjlT�� OR V } PI'T,�TI <br /> State possible vector potential & necessary control— <br /> X, <br /> 5 . TOILET/BATH FACILITts <br /> No . & location exi ;t1Lng,: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION 13-TDBY <br /> 7 . GENERAL SAt1I' ,1'I�� <br /> State any problems not previously noted : <br /> 8 . P } ' jl3 'Y <br /> Appx . 11o . People per sq . mi ._ <br />