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1 . SEWAGF <br /> Distance to Public Sewers Connection necessary: Yes Nc� <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain : <br /> Des�crib septic inst I atio�2o t�o ,-be installed : <br /> ✓%U,���e�G <br /> 2 . MATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes-,,K— No__ State deficiency : <br /> Does xisting or porposed use make this well pu7�lic water: Yes <br /> Nov_ 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 /> Potential problem: <br /> 4 . FLYL MOSQUITO OR V ^ � PSj'TTaNTIAL <br /> State possible vector potential & necessary control : le-dwee- <br /> 5 . TQI E / ATH FACILIlaa <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SAM'.�A _I0t1 <br /> State any problems not previously noted: �✓���' <br /> 3 . POPULATIQN DENSIT- <br /> Appx . No . People per sq. mi . �t'�'` �'G`' 1i✓��'r ��'� <br />