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1 • SEWAGR <br /> Distance to Public Sewers �� Connection necessary: Yes Noj(_' <br /> Does existing septic system comply with Ord. #549: Yes No_ <br /> Unknown If no, explain: <br /> De cri e s ptic in llat�i on to 'b i stalled: <br /> 2 . WATER SUPPLY <br /> Is water suppliedby private well , Yes � Pio Is well proper: <br /> Ye8.,4- No State deficiency:�O��" <br /> Does existing or porposed use make this well pic Water: Yes <br /> Nom_ Sample of well water taken: Yea NaublDate take <br /> Results Additional inforipation or comments �'s <br /> 3 . GARBAGE& REFUSE <br /> Licensed scavenger pick-up: Yes„4 No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MQSQUITQ OR VE^.TO _EC <br /> r � T <br /> State possible vector potentiztl & necessary control.. <br /> 5 . TOILET/BATH FACII,UES <br /> No. & location existing. � Additional <br /> facilities needed _ <br /> 6 . PR .VTOOS CP +.R_ATIIQM HI STM t <br /> State any problems not previously noted:, a <br /> 8 . 'QU ILATION DENSTT" � <br /> Appx. No. People per cq. <br />