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1 . SEWAGE <br /> Distance to Public Sewers -%' Connection necessary: Yes_ No_ <br /> Does existing septic system comply with Ord . 4549 : Yeses No_ <br /> Unknown If no, explain : <br /> Describe, septic i,ast lat ori b installed: ✓/�_ ✓.��> > <br /> � r �t` � ! F�r <br /> 2 . WATER SrTPPT,Y <br /> Is water supplied by private 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_ Plo__2,< Late t$ken <br /> Results Additional information or comments_ •�lazc <br /> 3 . GARBAGF & REFUSE <br /> Licensed scavenger pick-up: Yeses No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4 . F L, M0113Q ITC) OR _yEQT0R ZLI T r <br /> State- possible vector potentir,l & necessary control : _. <br /> 5 . T4 .ET/BATH FACrLTTES <br /> No . & location existing: . -� _ Additional <br /> facilities needed <br /> 6 . PRFVIOr1S OPERATION HST , <br /> 7 . GENERAL SANT' LZL( N <br /> State any problems not previously noted : ��� <br /> 8 . PO ' IT,ATIi)NFi ,,7TY / <br /> APpx . No . People per sq . <br />