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w, d G-7-- <br /> Distance to Public Sewers Connection necessary : Yes_ No_ <br /> Does existing septic system comply with Ord . 0549 : Yes_ No_ <br /> Unknown If no, explain: <br /> s cJ s a . /sem A4vs 0&4,- -!v be- cru✓ fru <br /> W 10 cp. as eta . <br /> Describe septic instillation to be installed: <br /> 2 . WATER SUPPL`f <br /> Is water sup <br /> �,l7.ied by private well : Yes No_ Is well proper: <br /> Yes_ No_1�State deficiency : <br /> ✓t Q �� 1.2 -6oo-yy QGvkDv <br /> SAi Ae ,,,/// ofef <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 /> W1 /!.O Cray, - ' /e � /u <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes— No_ Service Area No . <br /> Other proposed disposal method, <br /> Potential problem: ��n v a r A f�c SSSS _ <br /> 4 . HY- MOSQUITO OR M^TO ECU I <br /> State possible vector p ntial & necessary control : <br /> (> <br /> - a 6=4y d- � ' u 9 <br /> 5 . TOILFT/BATH F6QIT,TTF.5 <br /> No . & location existing: _ Additional <br /> facilities needed <br /> 6 . PREVIOf1S OPERATION HISTORY <br /> 7 . GENERAL SAi]I,PATION <br /> State any problems nob previously noted: _e-�/y � 1C9 Lin <br /> 8 . P=1LATION DENSTTv <br /> Appx. No. People per sq . mi . <br />