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1 . SEWAGE r <br /> Distance to Public Sewers---- Connection necessary : Yes NO <br /> Does existing septic system comply with Ord . #549 : Yeses No_ <br /> Unknown If no, explain : <br /> Describe septic installation to be installed: <br /> ,Ss�c <br /> 2 . WATER SUPPIY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency: <br /> ?a re C. c,) w Cv-n yr c6 Pa 2 . <br /> Does xisting 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 /> 3 . GARBAGE & REFUSF <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FILL- MOSQUITO 'OR YE',-,'T R P2T�LL`�TIAL <br /> State possible vector potential & necessary control : <br /> 5 . TQ( ILEI/BATH FA(',IT,ITFS <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATIQU HISTORY <br /> 7 . GENERAL SANITALL <br /> State any problems not p"Vious ly noted : -- <br /> 8 . <br /> ioted : —S . POPULATION DEL=y <br /> Appx. No. People per sq . mi ._ <br />