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1 . SEWAGE� �W � <br /> Distance to Public Sewers Connection necessary : Yes— No_ <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain : <br /> Describe septic installation to be it}stalled: <br /> q�gaf✓ h4 2/on c Tse k 656/ n/ C- 'G . <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No_ Is well proper: <br /> Yes / No_ State deficiency: <br /> Does existing or porposed use make this well public water : Yes <br /> No Sample of well water -taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> GGr// e�?lf /-1L A/CL/.0 J114tL <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up : Yes_ No_ Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4 . ELY, MOSQUITO OR YECTOR POTENTIAL <br /> State possible vector potential & necessary control : <br /> 5 . TSIILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SA14ITATION <br /> State any problems not previously noted: - <br /> 8 . <br /> oted: _8 . POPULATION pEL=)L <br /> Appx. No. People per eq . mi . <br />