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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary Yes Noz <br /> Does existing septic: system comply with Ord . #549 : Yes y No_ <br /> Unknown If no, ex 1 in: <br /> - /' � �� �`!7 �F� /''o Gs.G/moo <br /> Des ripe s pti installation to be installed: �s ` G oo 4;4 <br /> -Wo LO'- d <br /> 2 . MATER SUPPLY <br /> Is wa er supplied b�� private ;cell : Yes 4 No Is well proper: <br /> Yes, No State deficiency : <br /> Does existing or porposed use make this well public water: Yes,�'L_ <br /> No Sample of well water taken: Yes Pao Date taken <br /> Results Additional information or comments �G.G <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLYSOM SQUITO �7�_Y c-i fir NTIAL <br /> State possible vector potentihl & necessary control . �6�E <br /> 5 . TGILET/BATH FACILITES A <br /> No. & locationexistir � <br /> /- �� '� Additional <br /> facilities needed .m-eif' 9`4 E© <br /> 6 . PREVIOUS OPERATION HISTDRY <br /> 7 . GENERAL SANITQII-M <br /> State any problems nc)t previously noted: �a�F <br /> 8 . PGPLTLATION DEt4,SITJ <br /> Appx. No . People per r q . 1111 .- lfE./-Z4:P �.X <br />