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1 . SEWAGE <br /> Distance to Public Sewers `1-�— Connection necessary : Yes No <br /> Does existing septic system comply with Ord . #549 : Yes No <br /> Unknown If no, explain: <br /> Describe }}ept installation to be installed : <br /> el 9E.1 <br /> 2 . WATER SUPPLY , <br /> Is water supplied try private well : Yes No Is well proper: <br /> yes-z— 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 talon <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 . FLYL MOSQUITO 02 MCTOR POMM AL <br /> State possible vector potential & necessary control : �f <br /> 5 . TQILET/BATH FAC 7jE_-- <br /> No . & location exiting: _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H LaTt)RY <br /> 7 . GENERAL SANITA-1100 <br /> State any problems not previously noted= ozeo G <br /> 8 . POPULATIQU DENSITY 1 <br /> Appx . No . People per 3q. mi . ��•P��� .�� ��-r��F <br />