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L SEWAGE /� �" <br /> Distance to Public Sewers (w'i pjxI d Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549: Yes No <br /> Describe septic installation to be installed: awl[ <br /> 1 WATER SUPPLY <br /> Is water supplied by private well: Yes No K Is well proper: Yes No <br /> State deficiency: <br /> Does existing or proposed use make this well public water: Yes _$c No_ Sample of well <br /> water taken: Yes No Date taken Results <br /> Additional information or comments: ti vr,D <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes -,X- No_ Service Area No. <br /> Other proposed disposal method: A440 <br /> Potential problems: ►sur..! <br /> 4. FLY, MOSQUITO. OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: /U f <br /> 5. TOFLETBATH FACILITIES N�h <br /> No. & location existing: <br /> Additional facilities needed <br /> 6. PREVIOUS OPERATION HISTORY <br /> L IVB <br /> 7. GENERAL SANITATION 1 <br /> State any problems not previously noted: VU/IU <br /> 8. POPULATION DENSITY ,tf/ <br /> Appx. number of people per square mile 0' <br />