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S :yam. ! � ;�•.._.c" 1 .� � r ;; � �� � ,�;f��r,, _ ,. � , , <br /> 3 . SEWAGE <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 /> D &ee115W-sejVic 'installation-to 'be insta led: '' �' /.•� Q <br /> t <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes � No Is well proper: <br /> Yes-Lz::f�No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> Noy'` 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. MOSOU_TTO OR VrsTOR POTEi TIAL <br /> State possible vector potentiftl necessary control: <br /> 5 . TOT .T/BATH FAQ: TES <br /> No. & location existing: ----� J" Additional <br /> facilities needed <br /> 6 . PREVTonS o2 ERAjToN HI InRY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> 3 . POPULATION DEHaTTV <br /> Appx. No. People per sq. mi . <br /> 7 � ! v <br /> ��� ) / 2 <br />