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1 . SFWAGV <br /> Distance to Public Sewers zz�yConnection necessary: Yes Nom <br /> Does existing septic system comply with Ord. #549 : Yeses. No_ <br /> Unknown If no, explain: / <br /> A�/W. <br /> Describe septic installation to 'be installed: �� <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes Z iso Is well proper: <br /> Yes No State deficiency: i/L� <br /> Does existing or porposed use make this well public water: Yes <br /> No--Z— 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-4 No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . =,,- M SQ ITQ QRy 'f'T0) MMUTIAL <br /> State possible vector potentiftl F& necessary control: <br /> 5 . TnT_LET/BATE FACILITES <br /> No . & location existing: ��� ��� l�� Additional <br /> facilities needed _ <br /> 6 . PREVIOUS <br /> OPERATION H I STM <br /> 7 . SENERAL SAIJITATION <br /> State any problems not Previously noted: <br /> f <br /> 8 . EOPULATIO14 DENISIly <br /> Appx. No . People per req. <br />