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1 . SEWAGE - <br /> Distance to Public Sewers Connection necessary : Yes No_ <br /> Does existing septic system comply with Ord . 0549 : Yes No_ <br /> Unknown If no, explain: {r/ <br /> .:fes' 0 C-- <br /> Describe septic installation to b ed: ✓ } � ��' �� <br /> 2. WATER SUPPLY <br /> Is water supplied by private ;cell : Yes -'-- -- o Is well proper: <br /> Yeses: No State deficiency : <br /> Does exipting or porposed use make- this well public water: Yes- <br /> No-,-'Sample <br /> esNo ✓Sample of well water taken: Yes Nom 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 probleir,: _ <br /> 4 . FLY. MOSQUITO OR V E^.TO ECi'j' ,NTIAL <br /> State- possible vector potential & necessary control : <br /> 5 . Tc7 LET/ ATH FACIj.JTES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HI STORY <br /> G/ . <br /> 7 . UENERAL SA14ITA`l'ION <br /> State any problems not previously noted : <br /> 8 . POPU .ATIOt4 DENST11 <br /> Apex . No . PeoTile per cc . mi . <br />