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SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_L <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain : pf <br /> 17 2 <br /> Descr e <br /> 2 . WATER SUPPLY / <br /> Is water su _ied by private well : Yes v v too Is well proper: <br /> Yes No State deficiency :. T �- .� �®.� -a S 5 a e144 <br /> ng ceeu-S <br /> Does e sting or porposed use make this well puVid water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Resu is Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up : Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: - <br /> 4 . <br /> roblem:4 . FLY , MG S . ] Q M-11,7- ) ECUX ll IAL <br /> State possible vector potentiftl & necessary control - <br /> 5 . Tit ILET/BATH F&Q1L= <br /> No. & location existing : Additional <br /> facilities needed __- <br /> 6 . PREVIOUS OPERATION HISTORY_ <br /> f .JR <br /> 7 . GENERAL SA14TTATION <br /> State any problems not previously noted: --- <br /> 8 , <br /> oted: --8 . PQPULATIQ1 922=-1 <br /> Appx . No . People per sq. mi .- <br /> � 9 <br />