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SKWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No_2S_ <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 <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 comments <br /> ,Id w` d,r�G.n.�.e 'fes K rtaL dp.��. us..-e u� o. 52-L' <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yea_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY . MOSQUITO OR VE.^.TOR POTENTIAL <br /> State possible vector potenti«1 & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed _ <br /> 6 . PRRVIOQS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted : <br /> 3 . POPULATION D .NSTTY <br /> Appx. No . People Der ai . mi . <br />