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, <br /> a6 S y <br /> 1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does ,,xisting septic system comply with Ord. #549: Yes No <br /> Describe septic installation to be installed: <br /> 2. WATr.:R SUPPLY <br /> Is water supplied by private well: Yes No Is well proper Yes No <br /> State &-ficiency: <br /> i it! � t-vel �vw< TSD <br /> Does existing or proposed use n €this well public water: Yes No Sample of well <br /> water taken Yes_ No _Date tgLken Resul <br /> Additional information or comments. Y e) I j 1 � r � l .s i i_ <br /> lir r <br /> 3 GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: / <br /> Potential problems: <br /> 4. FL'17. MOSQUITO. OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. TOILETBATH FACILITIES <br /> No. & location existing: ------ <br /> Additional <br /> Additional facilities needed <br /> 6. PREVIOUS OPERATION HISTOR <br /> 7. GENERAL SANITATION V S 8AI6.A -"Z h 2 5 <br /> State any problems not previously Py _,e_0 7_1-�f yo` <br /> 4,51 <br /> 8. POPULATION DENSITY 7-t?,00�� ��e y U V$ ,0 p7l_7Gc�61/G�+G <br /> Appx. number of people per square mile <br /> G ✓ <br /> hyo'» ► 5 t , :G of T ✓r� el a �' ,. J -� T Q-3�i <br />