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SCANNED <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 instal ion to 'be installed: <br /> U <br /> 2. MATER SUPPLY <br /> Is water suppliedby private well : Yes 'Not/ 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 <br /> .cry, //1�� S .� �i v 4 S i�/�i ) 1 A 1 .0 t' s3_moi�/P y�,� <br /> --,F- r {r�r C"i. "' ` , u/ <br /> 3 . GARBAGE & REFUSE <br /> Licenaed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOSQUITO OR VM^.TOR PUEZiNTIAL <br /> State possible vector potential et necessary control: <br /> 5 . TOILET/BATH FAQILITES <br /> No . ec location existing: Additional <br /> facilities needed <br /> 7 . GENERAL SANT _ T ON <br /> State any problems not 'M!671 us ly noted: <br /> S . POPULATION DENaTTY <br /> Apex. No. People per eq . mi . <br />