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dY f RRMAGE <br /> Distance to Public Sewers Connection necessary: Yes ,,No-,,,_, <br /> Does existing septic system comply With Ord. #549: Yes ✓ No_._. <br /> Unknown If no, explain: <br /> 1 <br /> Describe .septic fns allation to 'be installed: <br /> i - Ute- - - -- <br /> I o <br /> 2. WATER SUPPLY <br /> Is water a! pg ied. by private well : Yes '� Na Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well pub 11c water: Yes <br /> No - Sample of well water taken: Yes No ✓Date taken <br /> Results Additional information or comments <br /> 3. GARBAGE & RRFUSFI <br /> Licensed scavenger pick-up: Yes No Service Area No._____-,—__ <br /> Other proposed disposal. method:_ <br /> Potential. problem: <br /> 4. 0 0 <br /> State possible vector potent'14tl & n/essary control: <br /> 5. TOILET/BATH FACTL ITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PREVTOGS OPREATIOti H O <br /> r <br /> 7. GENERAL SaNT <br /> State any problem~ not previously noted: <br /> E / <br /> i 3 . POPULATION DFaSTTY <br /> Appx. Wo. People per .eco. mi. <br /> I <br />