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1 . SEWAGE <br /> Distance to Public Sewers A/40m9nnection necessary: Yes NoA-,-- ' <br /> Does exist septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> yc <br /> / / G <br /> cr ptic i tallat on t be i Bta lgtl: <br /> JV <br /> y� <br /> 2 . WATER SUPPLY <br /> Is way er supplied by private well : Yes o Is well proper: <br /> Yes r 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 /> 3 . fW6ARBAGE & REF tS . <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4 . FLY , MOSQUITO OR yE.^_.TGR POTL'NTIAL <br /> State possible vector potential & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed- <br /> 6 . <br /> eeded6 . ORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted : _ _ <br /> S . PGPULATTQN DENSITJ <br /> Appx . No . People per sq. mi . <br />