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1 . SEWAGF� <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 /> ze 90 <br /> Describe septic installation to be installed: <br /> 2 . MATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency: <br /> Does a sting 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 <br /> ' ¢ <br /> U'h-e % 5 S - / Jf o I AA-x j S 07 ? W dlo7 2 s�G r <br /> 3 . GARBAGE & REFUSE c, /9_*111 rr ��t Qt r &Wq9—/ r <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: _ <br /> Potential problem: <br /> 4 . FILY,_ MOSQUITO O$ V QTO EC)LE_EIIAL <br /> State possible vector potentifil At necessary control : <br /> 5 . TOTTLF.T/BATH FACTj,I 'ES <br /> No . & location existing : Additional <br /> facilities needed _ <br /> 6 . PREVIOUS 0PERATIO14 HI STORY <br /> 7 . GENERAL SAI�ITATJQN <br /> State any problem: not previously noted : _ <br /> 8 . EQPULATIO14 DEstI,,TTY <br /> Appx . No . People per cq , mi . <br />