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a <br /> 1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes NoY-1- <br /> Does existing septic system comply with Ord . #549 : Yes No� <br /> Unknown If no, explain: <br /> Descri' a septic 4stallation t be installed " �. <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes _Z'No Is well proper: <br /> Yes., No State deficiency: _— <br /> Does xisting or porposed use make this well Public water: Yes <br /> No_ <br /> Sample of well water taken: Yes No Date taken <br /> Resul Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes--)ZNo Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . EL1, MQSQUITO OR V E2F=1AL <br /> State possible vector potential & necessary control �'�� <br /> 5 . TQILET/BATH FACI=.Ma <br /> No . & location existing : --- Additional <br /> facilities needed <br /> 6 . PREVIO ATION H=_aRy <br /> 7 . GENERAL SANITAI-1- }. <br /> State any problems not previously rioted: e <br /> 8 . PSi'tI TLATIt i U iSITY /� r <br /> Appx. No. People per sq. <br />