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SEWAGE -s <br /> Distance to Public Sewers Connection necessary : Yes No x. <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> T h­LZ 4 t T� ,rt e hQ <br /> De r i o e }lest: '0 o. <br /> 2 . WATER SUPPLY <br /> Is Water supplied by private well: Yes h_,"" No Is well proper: <br /> Yes NoState de iciency: <br /> Does uxtsttng pyo eso make iia mil public water: Yes <br /> No Sample of well water tarsen: Yes No_4,:---'Date taken <br /> Results - Additional information or comments 7 d Q .fl > ts Z�k/y <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential fip o lem: T r . SSS - T ' <br /> 4. FLY. MOSQUITO OR V eQ..TOR PO'rENTTAL � <br /> State possible vector potential & necessary control: <br /> 5 . TOILE /BATH FACILITES <br /> No. & location existing: ,4/A_ Additional <br /> facilities needed _ <br /> 6 . PREVTOGS OPERATTON HT STORX <br /> 22-2� <br /> 7 . GENERAL SANT. TTON <br /> State any problems not previously noted: <br /> 3 . POPQT,ATIOia PENSTTY <br /> Appx. No . People per eq . mi . <br />