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Above - j rare d iese t w.. 'r- �►/ ���y. «- <br /> , <br /> c :r:21 /7-5 cf/l p=lc <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 /> AL �. <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes Na Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make- this well public water: Yes <br /> Na Semple of well water tarsen: Yes No 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 Q$VZQ1 EC)LEtIZIAL <br /> State possible vector potentiFtl necessary control: <br /> 5 . TOILET/BATTI FACILITES <br /> No . & location existing: _ Additional <br /> facilities needed _ <br /> 6 . PREVIOna c_,,PI R.ATInij <br /> 7 . ORNERAL EANI'r,Al'It-)N <br /> State any problems not previously noted : <br /> 3 . EnPULATION DEt4,:)TTY <br /> Appx . No . People per cq. mi . <br />