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1 . SEWAGE <br /> Distance to Public Sewers ti„ Connection necessary: Yes_ Nom <br /> Does existing septic system comply with Ord . 0549 : Yes_ Nom <br /> Unknown If no, explain : <br /> /�Q �fzoTl.�-fil,-C'7-vrv, �✓� c�'C1rC_ '- - <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No=FIs well proper: <br /> Yes_ No_ State deficiency :_ <br /> Does existing or porposed use make- this well public water : Yes '" V <br /> No Sample of well water taken : Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scaven er pick-up: Yes_ No_ Ser ce Area No. <br /> Other proposed d posal method: <br /> Potential problem: <br /> 4 . ELY MOSVF PffTTidTIAL <br /> State possible vector otential & nessary control : <br /> 5 . TOILET/BATTI FACILITES <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PRF.VIOr7S OPERA T014 H ,T RY <br /> 7 . GENERAL SAtJIr �lA TON <br /> State any problems not previously noted: <br /> 3 . POPULATION DENSITY <br /> Appx. No. People per sq. mi . <br />