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i <br /> SEWAGR <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord. #549 : Yea No_ <br /> Unknown If no, explain: <br /> Describe septic installation to *be installed: <br /> aL_ � , 5 - ' <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency: <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 . FLY. M SO TTO OR VECITOR PQ'rZNTTAL <br /> State possibly: vector potentiftl P& necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed - <br /> 6 . PREVIORS O tiRATIOg HISTnRY / <br /> 7 . GENERAL SAPTITATION <br /> State any problems not previously noted: <br /> 8 . POPULATTON DEt STTY <br /> Appx. No. People per sq . mi. <br />