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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes No.L <br /> Does exi8ttng septic system comply with Ord . 0549 : Yes No_ <br /> Unknown If no, explain: <br /> /k)o <br /> Describe septic i stallation to be installed: <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'�ilic water: 'des <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> fx - y ' <br /> 3 . GARBAGE & REFUSE <br /> Licenced scavenger pick-up: Yes No Service Ar a No . <br /> Other,-proposed disposal method: <br /> Poten'tiaoblre,m : <br /> 4 . FLY S "TC) <br /> r ALL <br /> State possible ve for potentifti & neces y control : <br /> 5 . TOILET/BATH FACILITES) <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVTOUS CPERATION HISTO <br /> 7 . GENERAL SAJITTA"PION <br /> State any px;,6blemz not previously noted: - <br /> 8 . <br /> oted: -8 . POPULAT, bli DENSITY <br /> Appx. No . People per sq . r.,1 . <br />