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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 No <br /> Describe septic installation to be installed: L. V N6n� <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 ample of well <br /> water taken: Yes No Date taken Results <br /> Additional information or comments: ' <br /> 3. <br /> GARBAGE & REFUSE <br /> Licensed scavenger pick-up Yes ✓ No Service Area No. <br /> Other proposed disposal method: Y <br /> Potential problems: <br /> 4 FLY, MOSQUITO. OR VECTOR POTENTIAL y� ,, <br /> State possible vector potential & necessary control I A � <br /> 5. TOILETBATH FACILITIES <br /> No. & location existing: (V �' <br /> Additional facilities needed <br /> 6 PREVIOUS OPERATION HISTORY <br /> 7. GENERAL SANITATION ^ <br /> State any problems not previously noted <br /> 8 POPULATION DENSITY ` <br /> Appx. number of people per square mile / " <br />