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1. SEWAGE <br /> M � ti <br /> Distance to Public Sewers Connection necessary: Yes '�. No <br /> Does existing septic system comply with Ord. #549: Yes_ � No <br /> Describe septic installation to be installed- ac.C. <br /> kkkU <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes � 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: rLQ4 <br /> 3. GARB GE & REFUSE <br /> Licensed scavenger pick-up: Yes Y No Service Area No. <br /> Other proposed disposal method: _ <br /> Potential problems: YLcia•k „ ,,,..,,,, .,,_,.. <br /> 4. FLY, MOSQUITO, OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: I�cfY�Q <br /> 5. TOILET/BATH FACILITIES <br /> No. & location existing: <br /> Additional facilities needed <br /> 6. PREVIOUS OPERATION HISTORY <br /> 7. GENERAL SANITATION <br /> State any problems not previously noted: <br /> S. POPULATION DENSITY <br /> Appx. number of people per square mile <br />