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1 . SEWAGE <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 . MATER SUPPLY <br /> Is water supplied by private well : Yes 'No Is well proper: <br /> Yee No State deficiency : <br /> Does existing or purposed use make this well public water: Yes <br /> No .� Sample of well water taken: `des No Date taken <br /> Results Additional information or comments <br /> 3 . G E-A RE. M <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method:— <br /> Potentl.al problem:_,..._ <br /> 4 . FLY MOS )U I Tri...—Y28 _PSI'L I XUAL. <br /> State possible vector potentiftl c necessary control: <br /> 5 . TOI ET.l.BLM F ACMITRa <br /> No . & location existing : Additional <br /> facilities needed._ <br /> S. <br /> 7 . CEN RAL 521 Z°A,LT�-) <br /> State any problems not preriouuly noted: - <br /> 3 . <br /> oted:3 . Pn,PULAiI- I) 11Zul- 1 <br /> Appx. No. People i}r:r sq. mi. <br />