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1 . SEWAGR • ' /�� <br /> Distance to Public Sewers / Connection necessary : Yes_ No <br /> Does exist 9 septic system comply with Ord , 0549 : Yes_ No <br /> Unknown I£ no, explain: <br /> Describe sept.�q installation to be installed: <br /> �(i.,instal <br /> E_ <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No_ Is well proper: <br /> Yes" No_ State deficiency : <br /> Does a sting or porposed use make this well pu�c water: Yes <br /> No ample of well water taken: Yes_ No° Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes— No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem ' d &,'d Wdam.A,a �- <br /> S�Jc,§� � <br /> 4 . FLY . MOSQUITO OR Vj�^,T�oR Pc,Prl]TTA <br /> State p sable /yect9r potential & nec/essary control: <br /> Y'o sSib(.GSp ve to(ems,.,,. ,'I" <br /> 5. TQILS. C ^ <br /> No . Fi locatio xisting : Additional <br /> facilities neede <br /> 6 . U^ S <br /> 7 . GENERAL SANTT 1A ION <br /> State any problem not previously noted: <br /> 9 . POPULATION DFNSTTY <br /> Appx. No . 'People per eq. mi . <br />