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1 . <br /> SEWAGE <br /> Distance to Public Sewers _ Connection necessary: Yes NokT <br /> Does existing septic system comply with Ord. 0549 : Yes_; No_ <br /> Unknown If no, explain: <br /> Describe sept c t llation to *be inst�lied <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yeses No State deficiency : ���� ���> �� '� �m ✓r� - s �'� <br /> 4/k,,/, <br /> Does existing or porposed use make this well public water: Yes <br /> No ,T 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—K--., No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ZLLY_L MO,5QUITQ OR v ,^TC, PS)TLNTIAL <br /> State possible vector potentiftl & necessary control : �✓<' <br /> 5 . TOILET/BATH FACTT,11,ES <br /> No . & location existing: ��"_ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HIST=, <br /> 7 . GENERAL SA1i7TAZj_Q <br /> State any problem: not Previously noted : <br /> 8 . F >11 LZjDN )Z% ,-T „ f <br /> Appx. No . People per rjq. mi . <br />