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I . 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 /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yea No State deficiency : <br /> JJLV� /71 Lnf-,L <br /> VV <br /> Does existing or porposed use make this well public water : Yea <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or cUIt�IileTt'tG <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 OR Y ZQMQ�PS)T1,ETL <br /> State possible vector potential & necessary control: <br /> 5 . FILET/ ATH FACILIZEZ <br /> No . & location existing : _ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERAUOi1 H=f <br /> 7 . GENERAL SANIUIT-MU <br /> State any prol-)leme not previously noted - __- <br /> S . <br /> oted - ___S . POPULATIQ14 DENLITY <br /> Appx . No . People per sq. mi._ <br />