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,Distance to Public Sewers I'~ Connection necessary: Yes No f` <br /> " Does existing aseptic system comply with Ord. #549 : Yes No_ <br /> Unknown ' If no, explain: <br /> l�trvtiC? <br /> Describe septic installation to 'be installed: <br /> 2. SEATER SUPPLY <br /> Is Hater suppliedby private well : Yes � No Is well proper: <br /> Yes Na State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No.V- Sample of Nell water taken: Yea Na Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE EEFIISE <br /> Licensed scavenger pick-up: Yes ' No Service Area No. <br /> Other proposed disposal method: -- <br /> Potential problem:_,. (► -a- - — <br /> . <br /> ELY, MOSU Tri_nR v�_ MECTO- 11- PORM'TAL. <br /> State possible vector potential F& necessary control: <br /> 5 . TOILET/BATH FACILITES Additional <br /> No. & location existing: •• -- <br /> facilities needed_ <br /> 6. PREVIOUS OPERATION HISTORY <br /> T. GENERAL SANITAITON n <br /> State any problems not previously noted: YG <br /> 3 . <br /> B-ORULATIQM DRUaTTY <br /> Appx. No. People per .sq. mi. � � - <br />