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No uG ST� <br /> 1 . SEWAGE� <br /> Distance to Public Sewers �� Connection necessary: Yes No.X <br /> Does existing septic system comply with Ord. #549 : YesX No <br /> Unknown If no, explain: / <br /> Describe septic installation to 'be installed: <br /> AV AA-t bvi/-71 11016Z Avwc <br /> Z. WATER SUPPLY <br /> Is water suppliedb,7 private well: Yes X No Is well roper: <br /> Yes L No State deficiency: S re -h <br /> a r { ! <br /> Does existing or porposed use make this well public Water: Yes <br /> No Sample of well water tarsen: 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:—A/0 ^414-- <br /> 4 . =. M SQUITQ QRyE^TCS pC)MKIAL <br /> State possible vector potentiftl necessary control: <br /> 5 . T.QILET/BATH FACILITES <br /> No. & location existing: — Additional <br /> facilities needed _ <br /> 6 . PREVIOfTS OPERATION HISTO t <br /> S 70 �f <br /> 7 . QENERAL SANITATION <br /> State any problems not previously noted:- <br /> 8 . <br /> oted:-8 . POPULATT014 DENS <br /> Appx. No. People per req. mi. <br /> i <br />