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• <br /> 1 . SEWAGE <br /> Distance to Public Sewers - _ Connection necessary: Yes NoL <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 wa er supplied by private well : Yes' No Is well proper: <br /> Yes, No— State def iciency : - iY�i•��� a� 4/��.',�f <br /> Does existing or porposed use make this wellpub is water: Yes <br /> Nom_ 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 /> Other proposed disposal method: <br /> Potential problem: _ <br /> 4 . =, MOSQUITO OR_Y 'n ) MTBMI.AL <br /> State possible vector potentifi.l & necessary control : <br /> 5 . TQLI ET/BATH FAC I.L I7.Ta <br /> No. & location existing: ���-� . Additional <br /> facilities needed <br /> 6 . PREVIOUS QPERATION HISTORY <br /> eel <br /> 7 . GENERAL SANITAI'IIMN <br /> State any problems not previously rioted: <br /> 3 . POPULATIt DR415ITY 1 <br /> Appx. No . People per sq. <br />