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1 . SEWAGE <br /> Distance to Public Sewers _ Connection necessary : Yes_ Nom <br /> Does existing septic system comply with Ord . #549 : Yes--':L, No— <br /> Unknown— <br /> o_ <br /> Unk/Jn�own � If no, explain : <br /> fk.41e ✓ f�n ���U /o if/z4"64F <br /> /9'�e eq lam/ r 1 g�e'dii�F�� �cl/ttv v <br /> Describe septic installation to be installed: �/� <br /> 2 . WATER SUPPLY <br /> Is wa&er sy 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 & R . IS . <br /> Licensed scavenger pick-up: Yes— No-----'!�'Service Area No . <br /> Other proposed disposal met <br /> Pptten�,4,�l Problem: <br /> 4. L'LY MOSQUITO OR V + 9IAL <br /> State possible vector potential & necessary control : <br /> 5 . TQTTrT/BATH FACILITES <br /> No. & location existing : __ Additional <br /> facilities needed___ <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANIT-ATJ Qj <br /> State any problems not previously noted: _ <br /> 3 . POPULATION DEtJ�.ITy. <br /> Appx. No . People per sq. mi._ <br />