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1 . SEAQ <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 insta.-.1ation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No-� Sample of well water taken- Yes No Date t ken <br /> Results Additional information or comments �� ��, <br /> �%ji1�P�F,C..�i��.P�����,�����,l�c=fes 4/�<`"%y'•�cc�"ye'��/�s <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes., ,No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLLY_. MOSQ LT(_�OR VECTOR EC)i'rLNTIAL <br /> State possible vector potentiftl & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVTOOS CEER.ATIOtd HI ZORY <br /> 7 . GENERAL SANIT `PION <br /> State any problems not previously noted : 17z�l� <br /> 8 . POPULATIO11 DENSTTv ' <br /> Apex . No . People per 6q . <br />