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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 nBtalled: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes _. i'io Is well proper: <br /> Yes No State deficiency : <br /> DoeIr existing or porposed use make this well public Water: Yes <br /> Noy , Semple 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: <br /> 4 . ZLLY­L MOSG r TQ QB V ^.TQ, PC)M1TlA1L <br /> State possible vector potentiftl & necessary control : <br /> r <br /> 5 . TOILET/BATH EACIL�I 'FS <br /> No . & locution existing: / Additional <br /> facilities needed _ <br /> 6 . PREVIQQS CPER.ATI(_ N Hj,Tn , <br /> Of U, 1A LSjLZg re�{ � t o biAf <br /> 7 . O +.N +.RA . SANITA'1' -0 <br /> State any problem: not previously noted : __ <br /> 8 . POPULATION DEISTIv, <br /> Appx. No . People per 6q . m i . � " <br />