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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 installation to be installed: <br /> r'. <br /> 2 . WATER SUPPId <br /> Is water supplied by private well : Yes Nol_�_" 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 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method- <br /> Potential problem : - <br /> 4 . <br /> roblem : _4 . FLY-.,- OSOU I TO M ) F_CI'IXIHII L <br /> State possible vector potentiftl & necessary control : <br /> 5 . TQILET_ TA H FACILUE <br /> No . & location existing: --_.� Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION_ HISTORY <br /> 7 . GENERAL SANI'[Ljj_�_ff <br /> State any problems not previously noted- -- <br /> 3 . <br /> oted: -3 . PQPULAT_IQN_2FMJJY <br /> Appx. No . People per rc3. r,i .--- _-- <br />