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k { � <br /> I . SEWAGE <br /> Distance to Public Sewers Connection necessary - Yes No— <br /> �– <br /> Does existing septic system comply with Ord. #549 : _ Yes No <br /> Unknown If no, explain: <br /> Describe septic ipstallation to beinstalled: - <br /> ,1r�f/,®� <br /> 2 . MATER SUPPLY <br /> Is water supplied try private well - Yes , No. Is well proper: <br /> Yes NO State deficiency: 'rf' .i. !`t.-lf. .�. rf'r� * c .f 1- �'� • .._.:;:z ' <br /> Does existing or porposed use make this well public water: Yes <br /> No X Sample of well water taken: Yes Nom 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. FL.1--X015OUZTO OR VECTOR 20'r%NTIAL <br /> State possible vector potential & necessary control.: 'r` -�• <br /> 5 . TDILETlBATH FACILITES <br /> No. & location existing: - Additional <br /> facilities needed <br /> 6. FREVI0U5 OPERATION HI STDRY <br /> 7 . GENERAL SANTT TION <br /> State any problems not previously rioted: <br /> 8 . POPQTtATTOjJ DEUSITY <br /> Appx. NO . People per sq. -- <br />