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1 . SBSiF <br /> Distance to Public Sewers Connection necessary : Yes N6> <br /> Does existing septic system comply with Ord . #549 : Yee No <br /> Unknown If no, explain : <br /> Des ribe sept G. in t9alation to be installed: <br /> Ile <br /> 2 . WATER SUPPLY <br /> Is wp� er supplied try private well : Yes No Is well proper: <br /> Yes No State Deficiency: <br /> E✓ �c ,r/��� ��� .�'����,C � J��G/c`k 4'- % /f,�c°l,. �icfil-'�i► .fow'G%E� �.s� <br /> eel <br /> �g`�Ird� t�s��''�i�issC4 -Public, water : Yes <br /> Nom_ Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments e��� ✓�� d t <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes Z No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: __ <br /> 4 . FLY,,_ MOSQUITO Ofi YELTOR ECIMNTIAL <br /> State possible vector potential & necessary control: <br /> 5 . TOILET/BATH FAC .I a5 <br /> No . & location existing: T//� Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HLaM Y <br /> r <br /> 7 . GENERAL SANI'rAll0. <br /> State any problems not previously noted: <br /> 8 . Ap1px} . No. Peo I�'per 6q . rr,i <br />