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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No� <br /> Does existing septic system comply with Ord . #549 : Yes No <br /> Unknown � If no, explain: <br /> Describe septic installation to be installed: <br /> -ft SS e0sWeya e c . <br /> V <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes ✓ 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 /> &cur 11 bZ /J <br /> 3 . REFUSE <br /> Lice sed scavenger pick-up: Yes No Service Area No. <br /> Other roposed disposal method: <br /> Potenti 1 problem: _ <br /> 4 . M11- MOSQUITO OR Y ) ECMM TIAL <br /> State possible vector potential & necessary cont 1 : <br /> 5 . TQILET/BATH FACILI7T. <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> 8 . POPULATION DENSITY � <br /> Appx. No . People per sq . mi . <br />