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1 • SEWAGFi <br /> Distance to Public Sewers _ Connection necessary : Yes No= <br /> Does existipg septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> /— 7ta <br /> Describe septic installation to be installed: <br /> if <br /> s "i ' <br /> 2. WATER SUPPLY <br /> Is wa r supplied by private well : Yes i.Io Is well proper: <br /> Yes No State deficiency: <br /> Does e sting or porposed use make this well public Water: Yes <br /> No Sample of well water taken: Yes No Late taken <br /> Results Additional information or comments <br /> e ( &.e[/ �•v�us f la E Gf e S y Gf ) o �a� c� urP ll ��� <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY . MOSQ IITO OR VR TOR PO rf NTIAL <br /> State possible vector potential & necessary control: <br /> 5 . TQTLET/BATH FACILITES <br /> No. ek location existing: Additional <br /> facilities needed <br /> 6 . PRFVIORS OPERATION HISTORY <br /> 7 . GENERAL. SANITATION <br /> State any problems not previously noted: <br /> 3 . POPULATION D .NSTTX <br /> Appx. No . People per sq. mi. <br />