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1 . e111L1AGE <br /> Distance to Public Sewers Connection necessary: Yes No-L <br /> Does existing septic system comply with Ord . #549 : 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 ,nom No Is well proper: <br /> Yes, No State deficiency : <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 <br /> F2lf.5 /,K uX'-�! �T h3 L' LeS-er.( ham, cICI)II-d <br /> i <br /> 3 . GARBAqE & REFUSE <br /> License scavenger pick-up: Yes No Service,,��a No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . F-LLY-L MOSQUITQ0R u ,.TCS ZCi'j'rT, iTIQ1TL <br /> State possible vectp r potentiftl & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOi1S OPERATIOi� Hj�_TC1 i <br /> 7 . GENERAL SAt T " O <br /> State any problems not previously noted : _ <br /> 3 . EjnpULATION DFNd311v, <br /> Appx. No . People per rq . r;,i . <br />