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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes Nom <br /> Does existing septic system comply with Ord. 0549,: Yes /2-- No_ <br /> Unknown If no, explain: <br /> Describe sept c installation to 'be installed:.? d© � � l <br /> .liE9cf,Gi-/F <br /> Z. WATER SUPPI,`I <br /> Is water supplied. by Private well : Yes iso Is well proper: <br /> Yes-4 No State deficiency: <br /> Does existing or porposed use make thin well public water: Yes <br /> No_,,K/, Sample of well water taken: Yes No-Z.. Date taken <br /> Results Additional information or comments ,-!?�� " " � • <br /> 3 . GARBAGE & REFUSE <br /> " Licensed scavenger pick--up: Yes.:Z, No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> l <br /> ` 4. FLL9MnS0UITa CSR VE MP2P. °F MAIL <br /> State possible vector potential ?z necessary control: <br /> 5 . TnII,FT/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> F <br /> s. PfiEYTOU2 QEERATION .HISsM <br /> 7 . QENFRALSAI d2' TION <br /> State any problems not previously noted: <br /> 8 . BOPULATIO14 DEL�STTY <br /> Appx, No. People .per ..t3q-. . mi . <br /> f <br /> F <br /> i <br />