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1 . SEWAGE <br /> Distance to Public Sewers ^J Connection necessary : Yes_ No <br /> Does existing septic system comply with Ord . 0549 : Yes— No_ <br /> Unknown If no, explain : <br /> Describe septic installation to be installed: EZ <br /> ! <br /> R f - C <br /> 2 . WATER SUPPLY <br /> Is wl�. r supplied by private well : Yes No_ Is well proper: <br /> Yes_ No_ State deficiency:_ <br /> 100 (M Ayl <br /> Does existing or porposed use make- this well pttb is water: Yes Y-� 6E <br /> No Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> /vw c,. d -{v )be d,,rGd <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4 . EI . mosouin OR V zCTO mi'MI-T AL <br /> State- possible vector potential & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : - ()8.e -hlce-f Additional <br /> facilities needed <br /> 6 . PRE.yIons OPEgATIOt4 HISTOF•Y <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted : _ <br /> S . EnpU ATION DENSTTY <br /> Appx . No . People per sq . mi . <br />