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c�^L'j�(�� r <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 septic installation to 'be installed: <br /> Aa < <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes 'rho Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No Semple of well water tarsen: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & R .FUS . <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4 . FAY.- M0SQUIT,OR V11 P2M HZI-ALL <br /> State possible vector potentiitl "ec ssary control: <br /> 5 . TOILET/BATII FACILITES = <br /> No . & location existing. � Additional <br /> facilities needed _ <br /> 6 . PRFVT0M3 QPERAi'IOIN H <br /> i AJ <br /> 7 . GENERAL SANI'r,.AII-Q& <br /> State any problem: na t previously rioted : <br /> 8 . p=JLATIt)I4 Lir i T v <br /> Appx. No . People per rq . mi . <br />