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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 supplied by private well : Yes iso 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 . Fes„ MOSQUITO OR VE^TOS a2j'ENTIAL <br /> State possible vector potentiitl Fz necessary control : <br /> 5 . TQILET/BATH FAcl=-Es <br /> No . & location existing: LA0 Additional <br /> facilities needed <br /> 6 . PREVIOr1S OPERATION HHI T=, <br /> ALJ° CAMP ON R n1lliF.i J4''� 6,J1) 7-E;2 rOe Aloe. <br /> Lt <br /> 7 . GENERAL 5A U '1-A I—C)J <br /> State any problems not previously noted : _ <br /> 3 . EOPULATION DENSTTY <br /> Appx . No . People per oq . r;,i . <br />