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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 /> 6'u c <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 : <br /> emwk'� 4") r-U 1A;l c <br /> Does existing or porposed use make this well public Water: Yes <br /> No Sample of well water tarsen: 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 disp-cpa1jnethod: <br /> Potential problem: <br /> �a�Grr, <br /> 4 . � MOSQU LTQ Q "T�, PS,T .l�?� 0(i <br /> State possible vector potentiftl necessary control: <br /> 5 . TOILET/BATH FACUTTES <br /> No . & location existing: _ Additional <br /> facilities needed _ <br /> 6 . PREV10 5 OPERATION S OEX <br /> 7 . QENERAL 2MIT'r.ATION <br /> State any problems not previously noted: _ <br /> 8 . F-MILLATION DEQ <br /> Appx. No . People per rq. mi . <br />