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1 . SEWAGE <br /> Distance to Public Sewers /J/A Connection necessary: Yes NoX <br /> Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe <br /> Teeptic .-inJstallation1 to be installed: �y <br /> /O 16e ._C;fear! 6C 'cy.-c�,rye 'T� 7hP PLC(___dr2v ,-;�eS7;-.y��y,.,s 7�y' <br /> d du <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes Na Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well pub c water: Yes <br /> No ✓Sample of well water tarsen: Yes No Date taken <br /> Results 9 Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scav ger pick-up: Yes No Service Area No. <br /> Other proposed isposal method: <br /> Potential proble : <br /> 4 . Fll� MOSQUITQ OR V ^TOS EC)rELJTILL <br /> State possible vect r potentifil Rz necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing. _ Additional <br /> facilities needed _ <br /> 6 . PRFVTOTIS OP �.R-ATICN HIST R <br /> 7 . GENERAL SAP T t <br /> State any pro'bl not previously not d-- <br /> 8 . <br /> :_8 . 'O 1LATIO14 DEiJ,,TTv � <br /> Appx. No . People per r_:q. mi . <br />