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SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. DATER SUPPLY <br /> Is Water supplied by private well : Yes No well proper: <br /> Yes No State deficiency : <br /> Does eing or porposed use make this well public Water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> /Results Additional information or comments 2 ,�c/ �� ✓ %gaj� <br /> 3 . GARBAGE & RSFUSE - <br /> rzx—,o 52v 27 3 S� ais' s7� <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: -- <br /> Potential problem: <br /> 4. FLY. MOSQQT_TO OR VECTOR PO'rlNTIAL <br /> State possible vector potentiitl 8.c necessary control: <br /> 5 . TOILET/BATH FAC ,ITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6. PRRVIOnS O BRAT nN HT3jQRX <br /> 7 . GENERAL SAIT 'A' TON <br /> State any problems nod previously noted : <br /> 3 . POPU .AT nN DENS �{ <br /> Appx . No . People per sq . mi . <br />