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1 . SEWAGE� <br /> Distance to Public Sewers ��"'` Connection necessary : Yes Nom <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Des ribe septic installation/ to e installed: <br /> 02C-4.iX <br /> �•�.� _ � .{- r�_e 5✓r C fid'? n., . > e <br /> 2 . WATER SUPPLY <br /> Is water supplied _)y private well : Yes ,--/'4— No Is well proper: <br /> Yes�No State deficiency: <br /> Does existing or porposed use make this well public water: Yes :�<- <br /> No 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 . FLY, MOSQUITO ORC;TOR p-Ci'MU IAL <br /> State possibl.v�vect.or potentihl & necessary control : <br /> 5 . T T-, . ZBA H FACILrUE <br /> No. & location existing: _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H ^TORY <br /> 7 . GENERAL SANITATION <br /> State any problems no Previously noted: _ <br /> 8 . POPULATTQN DE,R;ITY <br /> Appx . No . People per Bq . mi . _ <br />