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1 . SRAGE <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 /> hreyG. E - <br /> Describe septic installation to 'be installed: �12 14 Lf AOL A - <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes do Is well proper: <br /> Yes No State deficiency: <br /> Does e lsting or porposed use make this well public water: Yes <br /> Noy Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licenaed scavenger pick-up: Yes ✓ 'No Service Area No. <br /> Other proposed disposal method: - <br /> Potential problem: <br /> 4 . FLY, MOSQUITO OR Vr.CTOR PO'[CNTTAL <br /> State possible vector potentiftl XA necessary control- <br /> AJ L? <br /> ontrol:AJO Al - <br /> 5 . TOTLET/BATH FACTLITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 1 <br /> 4e,-5,el e A c F <br /> 7 . GENERAL. SAITT:[ATTON <br /> State any problems not previously noted: <br /> S . POPULATION DENSITY <br /> Appx . No. People per aq . mi. <br />