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SEWAGE <br /> Distance to Public Sewers A) A Connection necessary: Yes No✓ <br /> Does existing septic system comply with Ord. #549 : Yes_ No— <br /> Unknown �f ex la n. <br /> O0I3f(r�(( (( 417, `13 - c s�sFcw ltacl I � c Ficrko( o�wt((�� <br /> aCu-cu"-g dF ' 4-t�r� ctw•..- �w.�u <br /> Describe septic installation £olbe instal ed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes ido_ Is well proper: <br /> Yes— No_ State deficiency:— <br /> Does <br /> eficiency:_Does existing or porposed use make this well public water: Yee <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 . F .Y. MOSQUITO R V O pSfENTTAL <br /> State possible vector potential & necessary control: <br /> 5 . TQILF.T/BATH FACTL TTES <br /> No . & location existing: Additional <br /> facilities needed —_ <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANTT TION <br /> State any problems riot previously noted: <br /> 6 . POPULATION DENSITY <br /> Appx. No. People per sq. mi . <br />