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i <br /> 1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes o.Z <br /> Does existing septic system comply with Ord . 0549 : Yes No-Z <br /> Unknown If no, explain: <br /> 6 - S 4& -kc' / cc <br /> Descfribe septic installation to 'be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : <br /> ��CS�"7^Vi" �XIS7 ►-e ��1'✓lt'L��C L���) C�r�� �-LLLL � ��'t�' cCi'r��'�j� i;.c'C�. <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 . _MOSQUITO QR V Z^.TO MMUTJAL <br /> State possible vec r potential & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: _ Additional <br /> facilities needed _ <br /> 6 . PREVTOUS nPERATION HISTOr <br /> -17, S `� cz'�trir S � fd s� lb'dS <br /> 7 . QENERAL SANITATION <br /> State any problems nat previously noted: <br /> 8 . pnptjLAT10N DFNSTIv. <br /> Appx. No . People per Bq. mi . <br />