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U (, ST / <br /> 1 . 5EWAGE. <br /> Distance to Public Sewers N1� Connection necessary: Yes N0.4 <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 SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes ' No State deficiency : <br /> 41 <br /> Does '•ex9.stling 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: /10 GArG� / •-�a` - S�ic� �c .� - - <br /> 4 . L MOSQUITO 0$ V E^TO PS'fjNj_TAL <br /> State possible vector potentiftl ?.c necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No . ec location existing : _ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HTSTngy <br /> 7 . GENERAL SANI't' 'l,A JO <br /> State any problem: not prevlou ly noted: - <br /> 8 . <br /> oted: _8 . M ILATION DENST11 <br /> Appx. No . People per cq . mi . <br />