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t w <br /> � <br /> Distance to Public Sewers 1ei"" Connection necessary: Yes No <br /> Does exis�tkng septic system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> /U o ✓+ �s av` i G-�o. e Kr S�r a T4 S'tr_� <br /> Describe septic installation to 'be installed: <br /> 2. WATER Si11_'Pi,Y r <br /> Is waw supplied. by private well : Yes No Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well pudic crater: Yes <br /> No ✓ 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 No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: �- <br /> 4. O <br /> F[�Y� C��Y��T EOTENTIAL <br /> State possible vector potlenliV;4 & necessary control: <br /> 5. TOILET/BATH FACTLITES <br /> No. & location existing. . Additional <br /> facilities needed zJ <br /> 6. pIIEvTOUS OPRRATTON HISIQBX <br /> 7. GENERAL SANITATION <br /> State any problems not previously noted: A)a''`-Q <br /> 8 . POPULATIQU DRNSTTY J � Cz- <br /> Appx. <br /> } <br /> No. People per eq. mi. G� <br />