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1 . SEWAGE `�� <br /> Distance to Public Sewers "'G- Connection necessary : Yes No's <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Desc ibe se tic ins ,all ion to be installed: <br /> 2 . WATER SUPPLY <br /> Is w r supplied by private well : Yes .4 Na Is well proper: <br /> YesNo State deficiency : <br /> Does existing or porposed use make this well p blic water: Yes <br /> No�_ Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes--- - No Service Area No. <br /> Other proposed disposal method : <br /> Potential problem,: — <br /> 4 . FLY, MOSQUITO OR V�s,Z1_E2r1RT1AL <br /> State possible vector potential & necessary control : <br /> 5 . TOTLET/BATH FACILITES <br /> No . & location existing : _ ___ Additional <br /> facilities needed ___—__. --_- <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 , GENERAL SANITATLLM. <br /> State any problems not, previously noted: t�vtg_� <br /> 8 . P t ' TLt?1J_12ER _1 <br /> AUpx . No . People per -:q . r,,i ._�`�/��J�t�c° �E-i'�•Df'�!' ��!''�i <br />