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1 . SEWAGE <br /> Distance to Public Sewers -19�506 Connection necessary : Yes No�-> <br /> Does existing septic: system comply with Ord . 0549 : Yes.Z No_ <br /> Unknown If no, explain: <br /> Describe gept c installat n to be celled: -fG�� �c%, .� 1 7� <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�4 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 . FLY. MOSQUITO Obi-YE.ryT-aFL-P-C)f=A // <br /> State possible vector potenti.0 & necessary control . y�iJ�f <br /> 5 . TQLILI ET/BATH FACILII,ES <br /> No . & location existing : Additional <br /> facilities needed __ <br /> 6 . PREVIOUS OPERATION HI3TORY <br /> 7 . GENERAL SANITATTO.N <br /> State any problems no � previou.sly noted: <br /> 8 . I' _D EaJITY <br /> Appx . No . People per MI .A-- <br />