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1 . SRWAGE <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 /> Z . WATFR SUPPLY <br /> Is water supplied by private well : Yes _ ilo_ Is well proper: <br /> Yee_ No State deficiency: <br /> Does existing or porposed use make this well public water: 'les <br /> No_.. Sample of well water taken: yes_ No_ Date taken <br /> Results-- Additional information or comments <br /> 3 . GARBAG5` & [1EFUSF. <br /> Licensed scavenger pick-up: Yes— No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem:_ <br /> 4 . F .Y. M SQUTTn F. Y F".T0 Zi'�, <br /> State possible vector potential &s necessary control: <br /> 5 . TOILFT/BATA FACT ,IE32 <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOris CPrRATmN HT,T(1RY <br /> 7 . GENERAL SANITA' IQQJJ <br /> State any problems not previously noted: <br /> 9 . POMMA T InN nF^ ^T <br /> Appx. No . People per sq. mi . <br />