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1 . SEWAGE <br /> Distance to Public Sewers —dL Connection necessary: Yes_ No <br /> Does existing septic system comply with Ord. 0549 : Yes No_ <br /> Unknown If no, explain: <br /> rhZlo Ifs , <br /> ///9� it1• NQl 99 — t* 353 84- /4l1 <br /> Describe septic installation to be installed: <br /> N o f 4A"' a- �/,ra4ra,:, c a <br /> 2. WATER SUPPLY <br /> Is water supplied- by private well : Yes `/iio_ Is well proper: <br /> Yes✓No_ State deficiency: <br /> Does ee�c.-i�sting or porposed use make this well public water: Yes <br /> No 'T Sample of well water taken: Yes_ No✓Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yea_ No_ Service Area No. <br /> Other proposed isposal method: <br /> Potential proble <br /> 4. FLY, MOSQUITO OR Vi TOR POTENTTAL <br /> State possible vett potential & natesary control: <br /> 5 . TOT . .T/BATH FACIT,TTES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7. GENERAL SANITATION <br /> State any problems of previously noted: <br /> 8 . POPUT.ATTOM DRO TTX <br /> Appx. No. Pe le per sq. mi. <br />