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1 . SRWAGs <br /> Distance to Public Sewers Connection necessary: Yes No-->< <br /> Does existing .- septic system comply with Ord. #549 : Yeah No_ <br /> Unknown If no, explain: <br /> Des r be eptic installation to 'be installed: <br /> 2. WATER SUPPLY <br /> Is water supplied. by private well : Yes �,Nosviell proper✓- <br /> Yes,4 No State defici;:ncy:. ' � r¢i <br /> ,0'44 <br /> Does existing or porposed use make t}iis well public Water: Yes <br /> No Sample of well water taken: Yes N Date taken <br /> Reau Additional information or commen , <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, MOSdUITQ QR VE TnR pu +,NTIAL <br /> State possible vector potential & necessary control:_�o� .— <br /> f ' <br /> 5 . TOILET/BATH FArIL1TE <br /> No. & location exioting: Additional <br /> facilities neededr <br /> 6. PREYTOna OPERAITON HISIORX <br /> 7 . GENERAL S,&jjjjATTQN <br /> State any problems not previously noted: <br /> Appx. No. People per .req. ,� . ✓ ✓i <br />