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1 . SEWAGF <br /> Distance to Public Sewers }20o Connection necessary: Yes No .1-1- <br /> Does <br /> ✓Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unknown ✓ ��I-��xP�'a"e• �� sk rl C p �"f S. v. 0.) <br /> aQ�/,Y•,,'/ / 9Z -2/C�S ) � �Lfy/iC 1s1/4 �'7 <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is wa r supplied by private well : Yes V"�'No Is well proper: <br /> Yes No State deficiency : <br /> Does �cisting or porposed use make this well public water: Yes <br /> No—V-- 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. FILYL MOSQUIJQ OR VZEC)E2NTIAL <br /> State possible vector potentiftl & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . ec location existing! Additional <br /> facilities needed <br /> 6 . PREVIOUS OP .RATION HISTORY <br /> 7 . GENERAL SAZITA`1'ION <br /> State any problems not previously noted :- <br /> 8 . <br /> oted :-8 . POPULATIO14 DEi T v <br /> Appx. No. People per eq. mi . <br />