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1 . SEDGE <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 /> Z . WATER SUPPLY �l <br /> Is water supplied by private we.11 : Yes No kIs well proper: <br /> Yes No State deficiency. <br /> Does existing or porposed use maks: -thin well public water : Yes <br /> No Sample of well water taken: Yes No_ Date taken <br /> Results Additional information or <br /> f,//-�'�-,-: ,•,��y�/,��9�fes?/ ����/�.-��/c � �-�-c �dam✓/.-'6�r�f� <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLYL MQSQUITO OR Y Ec TQ F-C)MI -IAL <br /> State possible vector potential & neces-sary control ., <br /> 5 . TOILETZBATH F CILI1.1a ' <br /> No. & location existing: �� �"�'�9� i.�����/'fl Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H=E ' <br /> 7 . GENERAL SANITATa)U <br /> State any problems not prev_-our-,J.y noted: <br /> 8 . )I.1 1LATIQ14-. iE,y"i=Y <br /> Appx. No . People per sq. mi . <br />