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Y , <br /> 7' r. <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 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 taken: Yes No Date taken <br /> Results Additional information or comments " : - ✓` L���%t v,, <br /> IM <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY. MOSQUITQ QR y QT0_ R P0'[j;,NTTAT. <br /> State possibly: vector potential & necessary control: <br /> 5 . TOILET/BATH EACIL,TTES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PRFVTOna CP 4R,ATIOM HTSTORY <br /> /t z C y Cu <br /> L <br /> 7 . GENERAL SAitITATIQU <br /> State any problems not previously noted: <br /> 3 . POPULATION DE TTY <br /> Appx. No . People per sq. mi . <br /> r <br /> r <br /> L ��cV <br />