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1 . 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 /> Describe septic installation to be installed: c� <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes �iJo } well proper: <br /> Yes ' No State deficiency : <br /> Doxisting or porposed use make this well public water: Yes <br /> Noes�' Sample of well water tarsen: 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 . EWL- MOSQUITO OR V ^.TO ZC)MNTT_AL <br /> State possible vector potentiitl & necessary control: ��'( <br /> 5 . TOILET/BATH FArILrTFS <br /> No . Fc locution e.cistii�g : % Additional <br /> facilities needed _ <br /> 6 . PRFV IO02 OPERATIQN OF:Y <br /> �cl✓i�E�y�i� �C' <br /> 7 . GENERAL SAiU A1I01i <br /> State any problems liot previously noted - <br /> 8 . <br /> oted :8 . EMILLATION Dr t1STTv <br /> Apex. No . People per r_:q. <br />