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1 . SEWAOR <br /> Distance to Public Sewers Connection necessary: Yes No_ <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 /> Yee 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 /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem:________�. <br /> 4 . FLY, M�tiUTTO_ �R V _ f.�t�'CL�L <br /> State possible vector potentiftl Fz necesaary control: <br /> 5 • Tn.ILETIBATR e CF.i <br /> No . & location existing : d Additional <br /> facilities needed—_. - <br /> 7 . G-UiiT Ta Tcad <br /> State any pro )lem. not previouis ly noted: <br /> Appx . No, People x. or sq. mi . - <br />