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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes No_ <br /> Does existing septic system comply with Ord. 0549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: rV' <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yeses No State deficiency : <br /> Does existing or purposed use make this well public water: Yes- <br /> No 4,;- <br /> lesNom= Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> ther proposed disposal method: <br /> P ential problem: <br /> 4 . FLY Q 013 VEQTC)RPC�rjjNTJAL_ <br /> State ssible vector potential & necessary ontrol : <br /> 5 . TOTLFT/BATH FA <br /> No. & location exist g: _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATT014 HT- ORX <br /> 7 . MEJUU.L " ZTTATTOM <br /> State an problems not previously noted : _ \ <br /> 8 . F'��1}[Ii,ATTtlT1 tFi "T <br /> Appx . No . People per cq . mi . <br />