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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yes No- <br /> Ura"ar�..- <br /> Describe reptic installation to be installed : <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes —No Is well proper: <br /> Yes No State deficiency: -- <br /> Does ex�ting or porposed use make this well public water: Yes <br /> _ <br /> Nozf Sample of well water taken: -`e f3 No Date taken <br /> Results Additional information or comment 9 ? i clzj'64 <br /> s "0-&6_J pru�o�s - <br /> 7 <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: _ <br /> 4. =L MOSQUITO OR YZQTQR PSMMIAL <br /> State possible vector potential necessary control : <br /> 5 . TQILET/BATH FACILUES <br /> No . & location existing: — Additional <br /> facilities needed- <br /> 6 . <br /> eeded6 . PREVI 11r, QPRRATION HISTDn <br /> tl� op <br /> 7 . GENERAL SANITA' LQ-tj <br /> State any problems not previously <br /> 8 . POPULATIQN DEi , j <br /> Appx. No . People per sq. mi . <br />