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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: r� <br /> �t.aa. � rt,tnR" f <br /> 2 . WATER SUPPLY <br /> Is wz%ter supplied by private well : Yes - No 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 tarsen: Yes iso 'i Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . =,_ MOSQUITO QB VECTOR^TO ZC)rLHTI11;L <br /> State possible vector potentii,l necessary control : <br /> 5 . TO ET/ ATH FACILITES <br /> No . & location existing : — Additional <br /> facilities needed _ <br /> 6 . PREVTO02 OPERATION H13-= <br /> av vV� LX C// � rZ /75 <br /> 7 . GENERAL SAPU'r,,AlION <br /> State any problems not previously noted : _ <br /> 8 . F'O ' 1LATION DE.NISTIY <br /> Apex. No . People per rq . r,i . <br /> "� <br />