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1 • SEWAGE �/ <br /> Distance to Public Sewers �f4 Connection necessary: Yes Nom <br /> Does existing septic system comply with Ord . 0549 • Yes No <br /> Unknown y <br /> Describe sept c .installation to be installed: <br /> ��' l��E .� i !✓lid � �G -- <br /> Fi � - �i1�.�7�'-PTr./y 7i-sr F�c�" `i � �9'✓7.-._ •��i' �� . �.... <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes No_ Is well proper: <br /> Yes No_ State deficiency! <br /> Does e fisting or porposed use make this well public water: Yes <br /> No Sample of well water taken : Yes_ No_� Date taken <br /> Result Additional information or comments <br /> 4/ t i2 t �� ��c.P-/'F��t1'r �i,lliGi,�°��,1�✓ .fFrc��i�F_7.����..' <br /> 3 . GARBAGE & REFUSR <br /> Licensed scavenger pick-up: Yes No_ Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4 . FLY, MOSQUITO OR VECTOR POTENTIAL <br /> St,pte pos ible vector potential & neyressary control- 0/e <br /> �c .I�/., f9Q;O.9 �;z%;Ass�6 .Yc�l/�l✓f� ./:O�C�.r i/L <br /> 5 . TQILET/BATH FACUITFS <br /> No . & location existing : ��F®� ���y-"��� `' - Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATI—(N <br /> State any problems not previously noted : �-/e�— <br /> 8 . POPULATION DENSI7._L <br /> Appx. No . People per sq. mi . ������ C�tc� <br />