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1 . EEWG <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 /> 'AUo / c D' I V cz c <br /> Describe septic installation , be installed: <br /> 2 . WATER SUPPLY <br /> Is water splied by private well : Yes No - Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well pt! is water: Yes <br /> No — Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBACE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: - <br /> Potential problem: <br /> 4 . =,,- MOSQITQ QR V ^.TO Z2f=AL <br /> State possible vector potentiEtl & necessa control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> 6 . PREVIOPS OPERATION HISTO 1 / \' <br /> 7 . GENERAL SAP 'r LO <br /> State any problems not previously noted- <br /> ;7 — <br /> 8 . EQ QLAT ON DR-4STIX \ <br /> Appx. No . People per rq . mi . <br />