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1 . SEWAGE <br /> Distance to Public Sewers / Connection necessary: Yes_ No} <br /> Does existing septic system comply with Ord . 0549 : Yes No_ <br /> Unknown If no, explain : <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water s pplied by private well: Yqs No_ Is we 1 proper: <br /> Yes_ NoState deficiency :. �'��«f�e- <br /> 4�E�G /rim �v '^' 9 ,,e ��✓�LG�,/�.of.��./.��Ff /E.�� <br /> Does existing or porposed use make this well public Water: Yes <br /> No , Sample of well water taken : Yes_ NoDate taken <br /> Results Additional information or commen e <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yeses No_ Service Area No . <br /> Other proposed disposal method : <br /> Potential problem : <br /> 4 . FLY MOSQUITO OR —VECTOR ZCfJ dTIAL <br /> State- possible vector potential & necessary control : <br /> 5 . TQT , .T/BATH FACILITES <br /> No. & location existing: _ Additional <br /> facilities needed <br /> 6 . PREVTOf1.S OPERATION HLSTOFY <br /> 7 . G '.N1RA SANITATION <br /> State any problems fiat previously noted : ge"- c <br /> 8 . POPU ATTON E11-OITY <br /> Appx . No . People per sq. r,,i.���i�✓G�.lE —.PF//Lf�.✓ ,C <br />