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SEWAGE <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 /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY <br /> Is water ,_supplied by private well : Yes 110 Is well proper: <br /> Yes � o State deficiency : <br /> Does existing or porposed use make tlj.is well public water: Yes <br /> No . -Sample of well water taken: Yes�No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licenaed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . E , M0SQUTTc'��RyZ^.T( pS. MEZIAL <br /> State possible vector potentifll necessary control: <br /> 5 . 0TirT/BATH FACILITES Additional <br /> No . & location existing : <br /> facilities needed_- <br /> 6 PREVTOrti r1pri.pQTIOid HISTO r <br /> 7 . Q s <br /> atad <br /> State any problem: not •, i�ttt�l:y n <br /> 3 . pc,puT,ATT0N Dr S=__ /! <br /> Appx. No . People per rq. mi . - <br />