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1 . SEWAGE <br /> Distance to Public Sewers ^�I',16" Connection necessary: Yes No . <br /> Does existing septic system comply with Ord . #549 : Yes No <br /> Unknown If no, explain: <br /> U d <br /> Describe septic installation to be nstalled: <br /> n e- <br /> 2 . <br /> 2 . RATER SUPPLY <br /> Is water supplied by private well : Yes No4 Is well proper: <br /> Yes No State deficiency : <br /> Doe xisting 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 /> n <br /> d'o flS �n1a�ce <br /> 3 . GARBAGE & REFUSE <br /> Licenseds avenger pick-up: Yes No S ice Area No . <br /> Other propo ed disposal method: <br /> Potential pr lem: <br /> 4. FLY MOSQUITO �^.T OjL <br /> State possible vector potential ' ecessary control : <br /> 5 . TOTLET/BATH FACILITES <br /> No . & location Existing • Additional <br /> facilities needed <br /> 6 . PREVTOPS OPERATION HISTS U, <br /> 7 . GENERAL SANT TION <br /> State any problems not previously noted':,_ <br /> 8 . PO P ] .ATI_Q14 DENISTIX <br /> Appx. No . People per 6q. mi. <br />