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w <br /> 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 sept ' c instal lat.ion to be installed : <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes _4_ No Is well proper: <br /> Yes No State deficiency �a•��1�� . /�.`.��1�� ✓�9 �1��d9 ,` <br /> �r.->uys' �-.G" .�'�= ."cy,`,� -(:�.wr.: ., .• �s'FE -rte �e� .��✓ .��!o <br /> Does xi ti or purposed use make this well .public water: Yes <br /> NoSample of well water taken: Yes No4 Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes-4- No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4 . FLYS M0,5D.UIT)) OR MCI ) ZC)MR IA <br /> State possible vector potentifil & necessary control : � <br /> 5 . TQLET/BATH FACILI7- <br /> No . & location existing :-�Y --- Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION =DRY <br /> 7 . GENERAL SANT-hZILM. <br /> State any Problems not previously noted:.��� <br /> , ) T L�TL.II�jjajT� r <br /> Appx. No. People per sq. rr�3_ .��.�'/�d��,(�` ` �c�✓,���`'•✓�-q� <br />