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I <br /> 1. -SEWAGE <br /> Distance to Public Sewers A)1A Connection necessary: Yes No <br /> Does existing septic system comply with Ord. 9549: Yes No <br /> o e r r.4, o rc Goafr 41 <br /> �rYoCri./ eRt "'k -�tw.Q mer (a,7 L -rte 71z3C97 . <br /> Describe septic installation to be installed: /U tDrtioos-&W bu <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No ✓ Is well proper: Yes No nl lf <br /> State deficiency: A <br /> u.<<ti(ceC <br /> Does existing or proposed use make this well public water: Yes e of well <br /> water taken: Yes No ,,"Date taken �)r/Ar Results .J/'4 <br /> Additional information or comments: A,)o w-t' r' � •� ud�oL. <br /> Ure v S. Q,iv v t ot,.Q. &-W t cJa 4e" <br /> 3. GARBAGE & REFUSE � <br /> Licensed scavenger pick-up: Yes No ✓Service Area No. <br /> Otherro osed disposal method: <br /> P P P <br /> Potential problems: <br /> 4. FLY MOSQUITO. OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5, TOILET/BATH FACILITIES <br /> No. & location existing: /V rrrt� <br /> Additional facilities needed Uwfr- <br /> ntu., <br /> 6, PREVIOUS OPERATION HISTORY <br /> P-0- <br /> 7. GENERAL SANITATION <br /> State any problems not previously noted: <br /> S. POPULATION DENSITY <br /> Appx. number of people per square mile <br /> i <br />