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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. $1549 : Yea No- <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed:✓m��fi7�� r �7 <br /> f Ja r <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes 'Vo Is well proper: <br /> Yes No State deficiency: ✓' ��',r.I/ <br /> Does existing or porposed use make this well public water: Yes— <br /> No <br /> es <br /> Nom�__ Sample of well water taken: Yes No_�' Date to en <br /> Results Additional information or comments <br /> 3 . GARBAGE & RFFUSE <br /> Licensed scavenger pick-up: Yes Nom Service Area No. <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4 . <br /> roblem:4 . FLY, MOSOUTIQ QR VECTOR PO-E NTIAL <br /> State possible vector potentiril & necessary control: -��.✓f <br /> 5 . TOILET/BATH FACIT-TIE.S �' / <br /> No . & location existing: �y Additional <br /> facilities needed <br /> 6 . PREVTOna OPERATION HTSTnRX <br /> 7 . GENERAL SANT'[ATTnN <br /> State any problems not previously noted: <br /> 3 , POPULATTQN DEN ;TTY <br /> Appx. No. People per eq. mi . <br />