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1 . SEWAGE <br /> Distance to Public Sewers '` Connection necessary: Yes Nd�W_ <br /> Does existing septic system comply with Ord . #549 : Yes Nqc <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> Izz <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No� Is well proper: <br /> Yee No State deficiency : 1 <br /> Does existing or porposed use make this well public water: Yes- <br /> No "k <br /> esNom Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes/ Nb Service Area No . <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4 . FLYS M SQUITQ OR <br /> State possible vector potential & necessary control: <br /> �1 <br /> 5 . TOI , .T/BATH FACILITES <br /> No . & location existing : K- / Additional <br /> facilities needed <br /> 6 . PREVTO(TS OPERATION HISTORY <br /> U'di 1 t,4- Q L t LAU,4 <br /> 7 . GENERAL SANIT '1_A 'SON <br /> State any problem: not previously noted : <br /> 8 . ROPULATIO14 DEN ST " <br /> Apex . No . People per 6q . mi . <br />