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1 . SEWAGEs/ -a' r <br /> Distance to Public SewerConne=ction necessary : Yes No_ <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 SUPPIt'i <br /> Is water sup l-ied b1.7 private we.11 : Yes I/ i3o Is well proper: <br /> Yes No State deficiency :-7—'LL en.- I rn/f'�;� <br /> U r fi l.Pit cJ`J t .•%Q 3 7 /�F.:. � " <br /> Does existing or porpoAed 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 /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No__ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: _ <br /> 4 . FLY, MQSQ ITO OEY ';-T )I I' 3C�C` I <br /> State possible vector potential & necessary control : <br /> 5 . LI ETIBATH FACI=J,a <br /> No . & location exiting : __. _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HIST= <br /> 7 . GENERAL SANI" " _?!N \ <br /> State. any prohlems not previously noted - <br /> 8 . <br /> — <br /> 8 . FOPULATIOE_IFd.t=1 <br /> Appx. No . People per sq. <br />