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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes Nom <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain : <br /> Describe septic ns 11ation to be insta11ed: .1oi � <br /> Z . MATER SUPPLY <br /> Is water supplied by private wei�-: Yes -j(— Tao Is well proper: <br /> Yeses No__ State dei'iciency: <br /> Does existing or porposed use make this well public water : Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Resu ts Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes-Z— No Service Area No . <br /> Other proposed disposal method : <br /> Potential Problem: _,,: ✓ _ <br /> 4 . FLY MOSQUITO OR VECTOR POE NT1AL <br /> State possible vector potential necessary control : <br /> 5 . STILET/BATH FACILIJaa <br /> No . & location existing : _ _. Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HTST= <br /> 7 . GENERAL SANITA"1 M � / <br /> State any problems not previousl: noted- �Y� <br /> 3 . POPULATION DENSITY l / <br /> Appx . No . People per sq. mi.�/'�i{/��•e�'�/iCcC -rf�d' +' l�.d <br />