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AW <br /> 1. MAOR <br /> Distance to Public Sewers Connection necessary : Yea 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 Nater supplied by private well : Yes Na Is well proper: <br /> Yee No State deficiency : <br /> Does existing or porPosed use make this well public water: Yes <br /> No Sample of well water taken: Yes Na Date taken <br /> Results Additional information or comments <br /> 3 . CARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes Na Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. ZLLY_. MQSQUTTQ 4RY '" ZC'EENTIAL <br /> State possible vector potentiftl & necessary control : <br /> 5 . MILETIBATH FACILITES <br /> No . €c location existing: Additional <br /> facilities needed �jyy <br /> 6 !I C m D3X <br /> 7 . GENERAL SANITA'I' M <br /> State any problems not previously noted : — <br /> 8 . <br /> Appx. No . People per req. mi . <br />