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1 . SEWAGE Q h. <br /> Distance to Public Sewers 4 t Connection necessary : Yes. No_ <br /> Does existing septic systemcomply with Ord . 0549 : Yes jNo_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: !S f ' <br /> t'� rV7 641 'JJAIA i,v : i <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No-_ Is well proper: <br /> Yes. . No__ State deficiency : _-- <br /> Does xisting or porposed use make this 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 /> Licensed scavenger pick-up: Yes , No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. ELI, MOSQUITO OR Y QT r PS�j � T <br /> State possible vector potential & necessary control : 4 <br /> 5 . 1S►LIaET/BATH FACILI 'ES <br /> No. & location existing : - 4 _ c<.�.v� '6 �4 Additional <br /> facilities needed---- <br /> 6 . <br /> eeded -6 . PREVIOUS , ATjG Hj=a1 <br /> 7 . GENEEL SANITA,1,J_01. <br /> State any problems not previougly noted: <br /> 8 . A L AT 10 14_=R=1 _ �— <br /> Appx . No . People per sq. m1 -- ------------- --- <br />