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I . SEWAGE f <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 /> ` cry <br /> �' ,or <br /> Des i � nst& a ✓�rr e no a led: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes ✓ No State deficiency : <br /> Doeslex,,�.�ting or purposed use make this well pu:� is water: Yes <br /> No GG Sample of well water taken- Yes N0 ,11" Dat taken <br /> Results Additional information or comments n �1 <br /> t tJ Com/' 5 6 2 / ✓4e-&-1 4 C.-Gt o'Y> /_/" r' <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem : <br /> 4 . FLYS MOSQUITO OR VECTOR PO=jAL <br /> State possible vector potential & necessary control : <br /> 5 . TQILET/BATH FACIL�I`I'ES <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 /> POPULATION DENSITY <br /> Appx . No . People per sq. mi . <br /> TA-V <br />