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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 /> Unknown If no, explain: <br /> ,' f f 4.2 oliir�eC/ / /��®/d�c//�6�/f �E/Yf/jlG�E O /!/✓��F <br /> Describe septic installation to be insta7.led: PIf <br /> 2 . WATER SUPPLY <br /> Is wa&er s plied by private well : Yes —4No_ Is well proper: <br /> Yes_ 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 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes— No_--_!;�Service Area No . <br /> Other proposed disposal method : <br /> Pptenproblem,: / mss✓ .9Et t� 4 f t of <.a,� <br /> FN%f,i ra.l, C.s'.L.Ef.Cuc J9.0 ✓ ��/'i,CfJ •.�F o ):1 C.f.srf ✓'eety L fife .i.✓/dis "eAX1E <br /> 4. f MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : ___ Additional <br /> facilities needed_. <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATLQR <br /> State any problems not previously noted: <br /> S . POPULATION DENSITY <br /> Appx. No . People per sq. IYii . <br />