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L <br /> I . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yee No_ <br /> Does existing septic system comply with Ord. #549 : Yes No— <br /> Unknown If no, explain: <br /> Describe septic installation to "be installed: <br /> 2. VATER SUPPLY <br /> Is water supplied by private well : Yes 'Ho Is 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 /> 3 . GARBAGF .- R=,Ute. <br /> Licenced scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method:. <br /> Potential problem:._,._ <br /> 4 . FLY. MOSQUITO OF, yE TQR Poumm, <br /> State possible vector potentifll Fc necessary control: <br /> 5 . TOI ,F /BATF FA(ILLITES. <br /> No . ec locution existins ; Additional <br /> facilities needed- <br /> 6 . <br /> eecoed-6 . PRFVIQ0-QdHI�T�f? <br /> 7 . GENERAL �SAITITA 1010 <br /> State any prolblem.- not Previously noted: <br /> S . BQRULA'!iOIC L1''"1" <br /> APpx. No . Peof,,Ie per cq . mi . <br />