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1 . SEWAGE / <br /> Distance to Public Sewers Connection necessary: Yes_ Fio V <br /> Does existing septic system comply with Ord . #549 : Yes_ No_ <br /> Unknown If no, explain: <br /> If <br /> Describe septic installation to be installed: - <br /> A e'" <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes iia_ Is well proper: <br /> Yes_ No_ State deficiency :_ <br /> Does existing or porposed use make this we' public water: 7 <br /> No Sample of well water taken: Yes✓ No_ Date taken Lt C4�'1 <br /> Results Additional information or comments -- mow <br /> N'C:uS <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger Pick-up: Yes— No_ Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4 . FLy� MOSQUITO OF V E^TO PCfMJTIA , <br /> State po Bible vector potential & necessar control : <br /> 5 TOILET/BATH , (' <br /> No . & location exis ing : Additional <br /> facilities needed <br /> 6 . PRFVTO(1S OPFRATIOt HISTO <br /> 7 . GENERAL , <br /> State any probems not previou-sly no -d: <br /> 9 . POPULATION DEEN,ITY <br /> Appx . No . People per sq . vii . <br />