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1 . SFWAGF <br /> Distance to Public Sewers ;;LL= Connection necessary: Yes No' <br /> Does existing Aeptic system comply with Ord. #549 : Yes- No" <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: - <br /> 2 . MATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yee-.:_` 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 t ken <br /> ul <br /> Resis Additional information or comments SFr <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yesz' No Service Area No. <br /> Other proposed disposal method; <br /> Potential prob em- E.�2ai/f �ri'o,,_G�✓ %-�. �i.�. �1 <br /> 69o'��fl ✓'cam E ✓f ,/rs E 7�e.��9i� -no ,i i e;sW .11,4t�. <br /> 4 . Fly-L MOSQUIM O}3 V z^T0 P2rM= <br /> State possible vector potentiftl necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: %-'' _ Additional <br /> facilities needed _ <br /> 6 . PREVIOU OP FATIION HISTORY <br /> 7 . QFNERAL SAPJITATION <br /> State any problems not previously noted : <br /> 8 . ,O , 1LATIQN DEI.J,:)ITY <br /> Appx. No . People per aq. mi . <br /> I <br />