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�. 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: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes coo Is well proper: <br /> Yes No State deficiency: <br /> Does , existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . G A R B AREi <br /> Licenced scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: YtO'-� <br /> 4 . FLY , M SQUTT0 _Q2. _y RTC?R POrENTTAL <br /> State possible vector potentif►l Fz necessary control: <br /> 5 . TOILET/BATH Le A('jT ,ZTF.S <br /> No. & location existing : _ Additional <br /> facilities needed- <br /> 6 . <br /> eeded-6 . PREYMMS CPQ}? T O' aHT-Tngy <br /> 7 . G .N .RAS, RAIJITATTC)N <br /> State any problems not previouV ly noted: — <br /> IJ . PO',PULA..a TON t�te n,rT ..VL <br /> Appx. No . People sq . ml . <br />