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f . SEIIAGr.'a <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 /> Le .91-led <br /> 2. 11ATER S UPPL`I' N6 atDne-.<+zC- 0-'- I e <br /> Is water supplied- by private Well : Yes No Is well proper.- <br /> Yes <br /> roper:Yes No State deficiency: <br /> F ,. <br /> Does existing or porposed use make tliii ' ifeil public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> 7SE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: � <br /> Potential problem: u <br /> 4. ELY, 11QkUITQ QE ECT-OR PS?, 14TIAL <br /> State possible vector potential & necessary control: <br /> 5 . MILF.T/BATH EACILIT �S .y <br /> No. €i location, exi:tin8! Additional <br /> facilities needed _ <br /> 6 . PREYIQT72 <br /> 7 . SANTIAT <br /> State any problems no- previously noted: <br /> i <br /> 8 . LD- ULATIOIJ DEi� <br /> Appx. No . People per ..req. mi . <br />