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!�0 5 � ' = -� <br /> 1 . SEWAGE pyo/ e <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 SUPPLE <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes 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 /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service_ Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY� MOSQUITQ OR Y Z r; r ECI FENTIA _ <br /> State possible vector potentiFtl & necessary control : <br /> 5 . TQILET/BATH FAC LITS <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTC'�RY <br /> 7 . GRNFRAJ, SAX'- <br /> TT��T, <br /> State any PAP,leets not previously note�t : -T ko-1 t , ` e <br /> ell "h <br /> --�--� <br /> bV <br /> Appx. No . People per sq. mi — <br /> A".4 <br /> :i- . .- <br />