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3-F 75 �} <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 /> Describe sept c inst$ ation to 'be installe <br /> 2. WATER SUPPLY <br /> -t`.••'���` �•� f, <br /> Is water suppl`ied. b:� ri�ate well : Yes No Is well proper: <br /> Yes No State deficiency: <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 commentsr/��,' _.P <br /> �r <br /> 3 . GARBAGE & REFUSE <br /> Licenaed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOSOUTTQ•OR yr:TQR )'[F,,NTTAL <br /> State posgLible vector potential necessary control: <br /> 5 . TOILET/BATH FACILITF.., <br /> No . ec location exieting: Additional <br /> facilities needed <br /> 6 . O OPERATION ; O <br /> LA , <br /> r r <br /> dip <br /> 7 . GENERAL SANTTATTON <br /> State any problems not previously noted: <br /> S . POPULATION D .YSTTY <br /> Appx. No . People per eq. mi. <br />