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Distance to Public Sewers Connection necessary: Yes� ,_,.. <br /> rNo <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 � t r 2-/u 5 <br /> Is Hater supplied. by private well : Yes 'NO�I4 Plell proper: <br /> Yes_,i,No cy: � <br /> Does existing or porposed use make this well public Water: Yes <br /> No . Sample of well water taken: Yes No Date taken�____� <br /> Results Additional information or comments 7 <br /> 3 . GARBAGE <br /> Licenced scavenger pick--up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> i ` <br /> 4. FLY, MOSQUITQ QB—WT-0-0-0123 <br /> State possible vec potential & necessary control.: <br /> 5 . TOILETCATH EACILITES <br /> No. & location existing: Additional. <br /> r facilities needed <br /> 4 <br /> 6. PREYTOUSr. O.' HISTORY <br /> 7 • GENERAL SANITAXION <br /> State any problems not previously noted: <br /> S . EDEULaTlSI'TV <br /> Appx. No . People per .aq. mi. <br /> is <br />