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op <br /> ,..�. 04 <br /> -,D <br /> l. . SEW <br /> Distance to Public Sewers Connection necessary: Yes No � <br /> Does existing septic system comply with Ord. 4549: Yes No <br /> Describe septic installation to be installed. <br /> W p <br /> 2, WATER SUPPLY J <br /> Is water supplied by private well: Yesy No Is well proper: Yes No <br /> State deficiency: <br /> Does existing or proposed use make this well public water: Yes No Sample of well <br /> water taken: Yes No Date taken Results <br /> 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 problems: <br /> 4. FLY MOSQUITO. OR VECTOR POTENTIAL <br /> State p ssible vector potential & necessary control: <br /> 5. TOILETS FACILITIES <br /> No. & locat n existing: �x c� <br /> AdditionKaiities.needed r <br /> r <br /> 6. PREVIOUS OPERATION HISTORY <br /> � � s <br /> T GENERAL SANITATION <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY <br /> Appx. number of people per square mile . <br /> k <br /> I <br /> 771 <br /> e <br />