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1 . SAG <br /> Distance to Public Sewers -J/14 Connection necessary: Yes. Nom <br /> Does existing septic: system comply with Ord. #549 : Yes No_. <br /> Unknown If no, explain: <br /> w'-'t '- ''6- /1 (141 d,a-') <br /> Describe septic installation to '/be installed: <br /> /V oyLe a 7 44S T7 v- <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: 'les <br /> No / Sample of well mater taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBA GF & RSFUSR <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. M03AUTT4 OR V c) POTENTTAL <br /> State possible vectorp tentirtl �.c necessary control: <br /> 5 . TOILET/BATH FACTLITE5 <br /> No . ek location existir►g: Additional <br /> facilities needed _ <br /> 6 . PRRVIOns 0 rRAT, nI_N Hl ,_I FtY <br /> 7 . GENERAL SANT:EATION <br /> State any problems no-t previously noted: <br /> 3 . paPULATZoia DFNSTTY \\ <br /> Appx . No. People per eq. mi . <br />