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r <br /> 1 SEWAGE <br /> Distance to Public Sewers A Connection necessary: Yes No-Y\- <br /> Does exig septic system comply with Ord . #549 : Yes No_ <br /> UnknownstinIf no, explain: <br /> Describe septic <br /> ,, inst ation to b installed: <br /> / � uce,s - Q ISo <br /> 2 . MATER SUPPLY <br /> Is war supplied by private well : Yes No Is well proper: <br /> Yes No__ State deficiency : — <br /> Does existing or porposed use make this well pubic water: Yes <br /> No Sample of well water tarsen : Yes No L_ Date taken <br /> Results Additional information or comments <br /> e C� I'S e'-_ L,�& A) W <br /> 3 . <br /> Licensed sea nger pick-up: Yes No Service Area No . <br /> Other proposed isposal method <br /> Potential >roble�. <br /> 4 . FLY"- MOS OUITO Soh VEC POTI1'I`r_IAL <br /> State possible vector of ntia.l. & neces ry control : <br /> 5 . TQTI.FT/BATH FACILITES <br /> No . & location existing : —_ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTO <br /> 7 . GENERAL SANI'TATIJ-�H_ <br /> State any problems not previously noted: ---- <br /> 8 . P0PULATIt�N DEi�'TY <br /> Apex . No . People per sq. mi .-- <br />