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1 . SEWAGF <br /> oiDoeDistance to Public Sewers Connection necessary : Yes No— <br /> Does <br /> s existing septic system comply with Ord . 0549 : Yes No_ <br /> Unknown If no, explain : <br /> Describe septic installation to be installed: <br /> 2 . MATER SUPPLY <br /> Is w er supplied by private well : Yes tJo Is well proper: <br /> Yes No State deficiency ' <br /> Does existing or porpcsed use make this well public water: `les <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . lSE <br /> Licen d scavenger pick-up: Yes No Service Are No . <br /> Other p posed disposal method: <br /> Potential roblem: <br /> 4 . FLY. S ECT0r_EC)rr.N.IA,1L <br /> State possible vector patFntif�l �� necessar control: <br /> 5 . TOILET/BATH FACILITES \ <br /> No . & locution existing . Additional <br /> facilities needed _ <br /> 6 . PRFVTOQS OPERATION 0 <br /> 7 . GENERAL SA2 T T O <br /> State any 7111, <br /> ems not previously noted : <br /> 8 . Q ) t')N D^.I.,TTY <br /> App . No . People per re; . mi . <br />