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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes ` No_ <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic nstal lotion to be installed: <br /> 2 . WATER SUEajY <br /> Is water supplied by private well : Yes No� 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 takes: <br /> Results Additional information or comments ����'�'� '` X17, <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No—_ Service Area No. <br /> Other proposed disposal method: cern__ <br /> Potential problem: — <br /> 4 . FII. _I,AL <br /> State possible vector potentifil & necessary control : <br /> 6 . TQILET/BATH FACIL111a <br /> No . & location existing: �S-' .. Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H=TORY <br /> r <br /> 7 . GENERAL 'SANITA,l,s M. <br /> State any problems not previously noted- <br /> 3 . <br /> oted:3 . <br /> Appx. No. People per sq. mi . ���'9��/����1 eter'.•r'�i1C°i�9� <br />