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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 /> Describe Septic installati2jlto be installed: <br /> 2. MATER SUPPLY <br /> Is water supplied b:� p iv to well : Yes No ✓ Is well proper: <br /> Yee No State de 1 iq <br /> / n <br /> Does "isting or porposed use make this well pubic water: Yes <br /> No ✓ Sam le of well water taken: Yes No Date taken__ <br /> Results tj Additional information or comments <br /> l s A Qyatlailt — �'` a•�t ev1'`..sc-�-t (S avaIQ(a(e <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ELY MOSQUITO OR Vr.^.TOR PCWP 1.NTTA <br /> State possible vector potential & necessary control: <br /> 5 . TOTLET/BATH FACTUTE <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PREVIOUS OPERATION HISTORY <br /> a c a•• t o t <br /> 7 . GENERAL. SANTIAT ON <br /> State any problems not previously noted: <br /> 3 . POPIILATION DRNSTTY <br /> Appx. No . People per eq. Mi. <br />