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e <br /> T <br /> t <br /> i <br /> iEjEWAGE <br /> Distance to Public Sewers _ Connection necessary: Yes Nom... <br /> Does existing septic system comply with Ord. #549 : Yes-7- No— <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes 2L No Is well proper:. <br /> Yes No_,� State def iciency X69 C �•�� �� /sd ��r��d�,✓�� � <br /> :Ic�9•����>1.4o��.G�i�:G. �yisF ('�-r�dc�s�:�,-y.ff'.G�; �fl�rs.��.9�/� ,.Yu�..r <br /> - <br /> Does existing or purposed use make this well public water: Yes <br /> No_-2sl, _ Sample of well water takers: Yes No� Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes NO2(— Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . EILY,_ MOSQUITO OR_YEMB POMMAL <br /> State possible vector potential & necessary control : ov�,-oL <br /> 5 . TOIL,ETfBATH 'ACI tITE-a <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVI-QUS HISTORY <br /> 7 . QENERAL SANIIALLM <br /> State any problems not previously noted: - <br /> 8 .. • <br /> APpx. No. People per sq. mi. , �/����/l�r/ �'dF� -- -- <br />