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SEWAGE' \ \ �� <br /> Distance to..Public Sewers AIA- connection necessary: Yes No <br /> Does existing septic system comply with Ord. #1549 : Yes= No— <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: �rw <br /> f <br /> E <br /> 2. WATER SUEBLI <br /> Is Nater supplied. by private well : Yes No Ie 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 taken <br /> Results Additional information or comments <br /> i <br /> 3 . <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem! <br /> 4. FLY. MOSOUTTO QH V - OP_0'rEHjTAL <br /> State possible vector potential necessary control: <br /> 5 . T ILET/HATH FACTLITEri <br /> No. & location existing: � Additional <br /> facilities needed <br /> 6. PREVTOUS OPER61TOR HTSTOEX <br /> r o c <br /> 7. GENERAL SANITATION <br /> State any problem; not previously noted: <br /> 3 . POPULATION DENG111 A//p <br /> Appx. No . People per eq. mi. <br />