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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes Nor;,,— <br /> Does existing septic system comply with Ord . #549 : Yes Noy <br /> Unknown_ If no, explain: <br /> Describe septic installation to be installed : <br /> 2 . MATER SUPPIjY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes NoState d.eficiericy : ���+1.�✓6g.�a �� <br /> mar �E ,t�ioFo�fl e�`' Fi./' .�.✓/.Z°'�C��o v,�,o F✓c'G 9rD J.v/� c,�'n�ri A <br /> Does existing or porposed use make this well public water : Yee, <br /> No-,,L_ 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 . =L MOSQUITO ORSI;;"' ) MMMIAL <br /> State possible vector potential & necessary control - ,/6- <br /> 5 . TQI E ;BATH FAQ <br /> No . & location existing : AdditlDnal <br /> facilities needed---- <br /> 6 . <br /> eeded _ _6 . PREVIOUT; OPER `l=)N HIS ORY <br /> 7 . GENERAL SANITA`1'I M / = <br /> State any problems not previously noted - '! l <br /> 8 . EOPULATTQN DEUITY J, <br /> Appx. No . People per Bq. mi. <br />