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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 : ff <br /> /_� QX � S7iiYs. _S'r­c-)zge, CJ i5- z/SvS � ? tU ✓ T/ N�/s <br /> Tltaac+ri a Q�pt.i. ilatitb"be ina114d: <br /> 7'r <br /> 1" � / <br /> oell <br /> 2 . WATER SUPPLY <br /> Is watersppplied by private we11 : Yes No Is �ell proper: <br /> Yes No State deficiency: a 0U_ r �J � /� S <br /> c� �i'►'"d 5.S u�Y1��12 L�--G{/�: f T..� � /i t�� "`.i �-� LcJ GcJ r� � ac��t4� TJ <br /> Does existing or porposed use make this well public water . Yes <br /> No -f-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 . FL _y MOSQUITO OR IMI � ZCMEMJAL <br /> State possible vector potential & necessary control : <br /> 5 . TQILET/BATH FACILIZM <br /> No . & location existing : __. Additional <br /> facilities needed <br /> 6 . PREVIOD2 OPERATION HISTDRY <br /> w� c" L.. <br /> 7 . GENERAL SANITY A TID-d <br /> State any proi-)lems not Previously noted- <br /> 8 . <br /> oted:8 . POPULATIO14 D ,=-.vA- <br /> Appx. No . People per sq . mi ._ <br />