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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No< <br /> Does existing septic system comply with Ord . #549 : Yes )r' No_ <br /> Unknown If no , explain: <br /> Describe septic installation to be installed: <br /> a <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes I/ No_ Is well proper: <br /> Yee No_ State deficiency : <br /> Does Axisting or porposed use make this well public water : Yes <br /> NoSample of well water taken: Yes_ No_ Date taken <br /> Results Additional Anformation or comments <br /> ////` ((//�,�,n^fS <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No_ Service Area No . <br /> Other proposed disposal mexoc 1: <br /> Potential problem : f <br /> 4 . FLY . MOSQUITO OR V ^.TO PCfrNTTAL <br /> State possible v4c or potential & necessary control : <br /> r <br /> .n <br /> 5 . TOILET/BATH FACTLITES <br /> No . & location existing : 2 Additional <br /> facilities needed N , , <br /> 6 . PREVTOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> W k-- <br /> s . POPULATION DENSITY Sc- <br /> Appx . No . People per sq . mi . <br />