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1 . SEWAGR <br /> Distance to Public Sewers Connection necessary: Yes o_ <br /> Does existing septic system comply with Ord. #549 : Yes o_, <br /> Unknown- If no, explain: <br /> i,��q�^ r � �`�` I �(*,� ��'L'L'r<i d'�d: � /V��'• I /� 4 /7.V C�L G /� <br /> Deecrib septic ins allation Kg� <br /> be 3.stalled: <br /> y- F— lri ✓,G•-� kbf`Z /i•w .� /:Zi J_ ,SL Zapi• <br /> I <br /> 2 . MATER SUPPLY <br /> Is water suppliedby private ;cell : Yes No Is well pro er: <br /> Yes No State deficiency: <br /> 0111 <br /> Does existing or porposed use make this well public water: Yes <br /> No Semple of well water taken: Yea No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & R .F lSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. F�Y.L M SQUITQ QR V OT-O Mi'j' T <br /> State possible vector potentiftl necessary control: <br /> 5 . TGTLET/BATH FACILITES <br /> No. & location existing: Additio0a l <br /> facilities needed _ <br /> 6 . PREV1002 OPERATION HISTORY <br /> 7 . CaENERAL SAPIITATION <br /> State any problems not previously noted:_ <br /> 3 . EQPIILATIO14 DENSITY <br /> Appx. No. People per sq. mi . <br /> I. <br />