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a <br /> 1 . 28WAG L <br /> Distance to Public SewersConnection necessary: Yes No <br /> Does existing septic system comply with Ord . #549 : Yes Nom. <br /> Unknown If no, explain: <br /> i <br /> Describe septic installation to be nstalled: <br /> q i , <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes iJo FIs well proper: <br /> Yee No State deficiency : <br /> Does existing or porposed use make- this well public Water: Yee <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licesed scavenger pick-up: Yes No Service Area o. <br /> Otherroposed disposal method: <br /> Potent 1 problerr, : <br /> 4 . Fll.,_ MOSQUITO QR VEQTORZC)f=AiL <br /> State- possib e vector potentiftl & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: _ Additional <br /> facilities needed _ <br /> 6 . PRFVTorla OPcRATim4 HISTOF;Y <br /> 7 . GENERAL 2A1jj 'IA_'T(-)N <br /> State any pz ob}ems not previous ly notecl : — <br /> 8 • POPULATION Dr NST11 <br /> Appx. No . People per 6q . mi . <br />