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SEWAGE <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 /> 2 . WATER SUPPLY L5 <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes �, No State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or commentsTT`�► itrev✓�_y ori oma, <br /> 3 . GARBAGE & REF 1S . <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ELL1. MOSQUITO OR Efl-0-a-EC)MMAILL <br /> State possible vector potential Fz necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . ec location existing: Additional <br /> facilities needed <br /> 6 . PRFVTODS c; ; _ATION HIS'PORY <br /> r i <br /> 7 . T, ,, C <br /> State any problems not previou -�t—ed:_ <br /> 8 . ROPULATION DFL ^T v <br /> Ap Y. No . People per sq. r,,i. <br /> C <br />