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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- 1- <br /> Unknown If no, explain: <br /> Describe septic 1installation to be installed: �` F �•'�v�;'� .�.- <br /> 2 . WATER SUPPLE:. <br /> Is water supplied Ly private well: Yes _-K/ No Is well proper: <br /> Yes Nom State deficiency : �✓C,G l'Af��6 �n�y ,r ��'� <br /> � 1 <br /> Does existing or porposed use make this well public water : Yesl <br /> No /� Sample of well water taken: es No X/ Date taken <br /> Results Additional information or corr,Ments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No_- Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: _ __-- <br /> 4 . L ilia SoUJTO OR Y_Zi;T ) Mt'IJT TIAL <br /> State possible vector pc,tenti�il necessary control - <br /> 5 . <br /> ontrol -5 . TQILET/BATH FACILUES <br /> No . & location existing: _-_.—__ Additional <br /> facilities needed __— <br /> i <br /> 6 . PREVIOUS OPERATION HIST��RY <br /> 7 . GENERAL SANITA= <br /> State any probleir,s not previour-J 1 y, noted: <br /> A p p x. No . People per sq. mi . '��'T'9 ��i'a 6� /�• <br />