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1 . SEWAGE <br /> Distance to Public Sewers A✓Af�^ 'Connection necessary: Yes,Y No_ <br /> Does existing septic system comply with Ord . #549 : Yes Nom <br /> Unknown If no, explain: <br /> G � <br /> Describe septic ins allation to 'be installed: <br /> % - G-, <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No-. Is well proper: <br /> Yes No State deficiency : <br /> Doesexisting or porposed use make this well pu lie water: Yes <br /> No Y Semple of well water tarsen: Yes No , Date taken <br /> Results Additional information or comments <br /> 3 . -APTZM---E & REFUSE �., <br /> Licen dscavenger pick-up: Yes No Service hrea No . <br /> Other p oposed disposal method: <br /> Potential" <br /> otentia problem: <br /> 4 . EL S MOSQ Q QR VZ2­—T(A3–E2MV=ATL <br /> State possib vector potentiftl & nece zaary- <br /> control : <br /> 5 . TQILET/BATH FACIL,I ' f\, <br /> No. & location existing':,_ Additional <br /> facilities needed _ <br /> 6 . PRFVTOn2 OP ,RATION HISTD- X <br /> 7 . GENERAL SAt11!A1' -(M <br /> State any problems not previously noted: <br /> 3 . EOPULATIO14 T-)ENSITX <br /> Appx. No . People per Gq. rni . <br />