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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. 0549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : ���'f-G d�E -z"w"e,l <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 0-�< <br /> an/ fir' <br /> 3 . GARBAGE & REFUSE Cyd <br /> Licensed scavenger pick-up: Yes No--L, Service Area No . <br /> Other proposed disposal method: <br /> Potential probler,: <br /> 4 . =. mosouITO OR <br /> State possible vector potentiftl ?z neces.-ary control . <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed _ <br /> 6 . PRFyTona OP gA.TION HISTOFY <br /> 7 . QENERAL SAP�ITATj()N <br /> State any problem.- not previously noted : <br /> S . EOPU �ATIOid hE NSTIv <br /> A p p x . No . People per sq . r.ii . .��GO�����/�'Z'—�c�fi�F� -� <br />